Lick Granuloma In Dogs

A lick granuloma is not so often a serious condition, however, it's frustrating for both the dog and its owner.

Acral lick granuloma (a.k.a acral lick dermatitis) is a self-perpetuating skin condition caused by compulsive licking, an “itch-lick” sequence, so to speak.

The painful lesions are typically seen on the front part of the lower leg in dogs, most commonly the wrist or carpal joint of the front limb, tail base, and the hind limbs. The term is a combination of the location (“acral” = affecting peripheral parts) and the reason (licking).

Sometimes, a dog concurrently may have a number of lick granulomas. Lick granuloma can crop up wherever your dog can reach, particularly if your dog is a gifted contortionist.

While seemingly innocuous, continuous licking causes bare, hairless patches and ulceration or erosion of the superficial skin layers, leading to focal infection and marked inflammation of the skin.

Apart from the physical causes, this is also termed psychodermatosis as there is definitely a strong psychological factor involved (e.g., anxiety, stress, or OCD). To find some solace, these dogs hit upon a spot to lick and begin a cycle of self-trauma, irritation, and infection.

• Excessive licking of skin in one spot
• Alopecia or Hair loss in the affected area in the form of reddened plaques or nodules
• Eroded or ulcerated skin
• Scabbing or moistness
• Hyperpigmentation
• Itchiness

The treatment protocol is based on addressing the suspected cause of the lesion(s) and arresting the cause of self-trauma.

Combination treatments are often required depending on the underlying disease.

Anti-inflammatories: Topical, oral or injectable corticosteroids. Synotic (Zoetis),fluocinolone,etc

Antibiotics: Amoxicillin/cephalexin/clindamycin/ enrofloxacin (Baytril)

Topical ointments:Includes some combination of steroids, antibiotics, anti-inflammatories, pain medication, and capsaicin.

• Anti-irritant Vetericyn Plus Hot Spot Antimicrobial Hydrogel
• Surgery - Surgery may be opted, for when recurrence is a concern and if the lesion is small, and also if the underlying cause is not identified.
• CO2 laser and Cold Laser therapy - photobiomodulation
• Behavioral Therapy and Medications - Dopamine antagonists, like naltrexone and tricyclic antidepressants.
• Allergy therapy: Injectable Cytopoint or Apoquel may be prescribed or a hypoallergenic therapeutic diet can be tried (food elimination trial)

Topical ointments:Capsaicin or Bitter apple in topical products is often effective at curbing the itch.

Behavior training: Although a physical barrier is not a positive training method, it can give time for drugs to take effect and the dog may forget about the injury.

Shirts or sleeves, Bandages, muzzles, and E-collars may prevent the dog from licking or chewing stitches or the sore.

• The most important thing in prevention is to distinguish between physical and psychological causes in order to provide the proper management.
• As with other compulsive disorders, acral lick granulomas are usually manageable but cannot be completely cured.
• The key is to stop the Self-mutilation (the itch-lick cycle)
• To reduce the incidence of psychogenic stress responses, Environmental enrichment has been successfully used.

1. Increased human contact/ social-interaction time for individually housed dogs
2. Group housing for dogs
3. Obedience lessons for dog
4. Trick learning /play toys
5. Mental stimulation games to earn treats or food
6. Visually interesting activities
7. Individual hiding areas like boxes

Labrador Retriever, Doberman Pinscher, Great Dane, Golden Retriever, Boxer, Akita, Dalmatian, Irish Setter, English Setter, Shar Pei, Weimaraner

1. Cause:

In many cases, the exact cause is unknown. However, it is assumed to be caused by multiple factors that include both physical and psychological factors.

• Skin allergies or hypersensitivities (e.g. flea, food, and environment)
• Bacterial or fungal skin infections
• Ectoparasites (e.g. mites especially Demodex mites)
• Trauma to the skin (cuts, abrasions, bruises, etc)
• joint pain or osteoarthritis
• Neoplastic disease
• Neuropathies (nerve pain or sensory nerve dysfunction)
• The foreign body under the skin (splinters, grass awns, etc)
• Metabolic diseases (e.g. Cushing's disease or hypothyroidism)

2. Other psychological Risk factors:

• Highly active dogs that spend time alone most of the time
• Separation anxiety
• Behavioral problems (Stress, anxiety, compulsive licking, etc)
• Licking due to lack of mental or physical exercise or boredom
• Dogs who suffer from chronic pain conditions

3. Morbidity:

• Lick granuloma lesions typically start off crusty and erythematous, progressing to raised, condensed, alopecic nodules or plaques.
• The middle of the lesion is often reddish, ulcerated, moist, or scabby
• Hyperpigmentation of skin is usual
• There is no sex predilection. It affects male and female dogs equally.
• The median age is 4 years as it affects middle-aged or older dogs more

4. Mortality:

Young dogs have the highest mortality rate (usually it ranges from 10%–to 30%)

5. Diagnosis:

• Bloodwork to check for hormonal conditions
• Skin testing for bacterial infection/ Dermatophyte testing
• Culture for ringworm
• Skin scraping or trichograms
• Skin biopsy/ fine needle aspiration to rule out skin cancer
• Radiographs to look at the bones and joints
• Orthopedic exam to check for joint pain or problems
• Allergy testing for skin allergies/Food-elimination test for food allergies
• Neurological testing to check for nerve disorders
• Psychological tests to check for psychological causes

6. Prognosis:

Veterinarians usually give suggestions for the control or management of the skin problem since there is no proper cure.

Lick granuloma has a guarded prognosis.

Dogs that receive early diagnosis and appropriate treatment have a better prognosis than dogs with chronic conditions.

Regular health checks are recommended to ensure there are no secondary infections.

Even after recovery, your dog may not be in good health for a while, be aware that it takes time to fully recover and give them enough space until your dog is back to full health.

Contact your vet right away, if you notice:

• Your dog obsessively licking its legs or other parts of the body
• Alopecia/ulcerated skin with reddened plaques or nodules

• Lean boiled meats
• Chicken baby food
• Plain steamed or baked white fish (whiting, pollock, cod, haddock, etc)
• Mashed potato (softened with fish poaching liquor)
• Skinless, minced chicken or turkey
• Scrambled eggs
• Fibre rich foods: Apples, pears, oatmeal, and other foods
• Rice, sweet potato, mashed banana

If you suspect your dog has a lick granuloma, then it is time to get your dog examined and make an appointment with your veterinarian. Discuss with your vet to figure out the underlying cause.

Proper treatment of Infectious causes of Lick granuloma do extremely well and are not at risk of developing problems in the future.

Treatment may need to be evaluated often to stop relapse. The prognosis is excellent when it is diagnosed early. Typically, the dog's quality of life is improved by early treatment.