What is a lick granuloma?
A lick granuloma is an open sore on the skin caused and perpetuated by constant
licking. The correct medical term for this problem is Acral Lick Dermatitis.
It is generally located on one of the legs, usually near the carpus (wrist)
joint. Typically, the hair will be licked off and the area will be either raw
and weeping or thickened and scarred.
Lick granulomas usually begin with an itching or tingling sensation. The dog
responds to this by licking which serves to increase the itching or tingling
further. A vicious cycle quickly develops, creating a habit much like a child
sucking its thumb. Even if the problem that initiated the itching or tingling
sensation is gone, the licking habit continues.
Are there certain breeds that are more likely to do this?
Yes. German Shepherds, Dobermans, Great Danes, Labrador Retrievers, and Irish
Setters probably develop lick granulomas more often than other breeds, but any
breed is susceptible. In addition, male dogs are twice as likely to develop
these lesions than females.
Why does a dog do this?
There is no clear answer to this question but there are three basic views
on the subject. Some experts consider it to be a primary skin disorder, while
others see it as an allergic problem, or as a neurologic disease involving the
nerves in the area of the affected skin. It is likely that most lick granulomas
have more than one cause or a single cause with one or more contributing factors.
Often aching arthritic joints can be a contributory factor.
How is this condition diagnosed and differentiated from other skin disorders?
In most cases, the diagnosis is made based on the appearance and location
of the lesion and the observation that the dog has a compulsion to lick the
area. However, certain skin tumors, parasites, embedded foreign bodies, and
allergies can create lesions that look very similar. In addition, trauma that
causes bone fractures or nerve injury can also lead to constant licking, creating
a similar lesion. Therefore, if the diagnosis is in doubt or if the dog does
not respond well to initial treatment, fungal cultures, radiographs (x-rays),
and biopsies may be recommended.
How is a lick granuloma treated?
Many approaches have been attempted, but none have been successful in all
cases. Often, success is only achieved after several "trial-and-error" attempts.
The approach to treatment generally begins by trying to eliminate potential
psychological factors. Boredom and stress are important issues that should be
addressed. It has even been suggested that another dog be acquired to keep the
affected dog company and thus distracted from the licking cycle. Since this
approach may not be successful, it should only be considered in situations where
you have already thought of acquiring another dog and not as a primary line
If no initiating cause can be found and eliminated, various medications are
used. These fall into two categories: (1) drugs which reduce sensation or relieve
inflammation or (2) drugs which affect the mood of the dog. In many cases, a
drug in each category will be used simultaneously as a means of attacking the
problem from two angles.
Some dogs respond best to combination drug therapy and the use of restraint
collars. These collars (often called Elizabethan collars because of their appearance)
are wide enough to stop the reaching the affected area to lick. It may be necessary
for the dog to wear the collar for 6-8 weeks because skin conditions take a
very long time to heal.
Many dogs develop secondary bacterial infections within the lick granuloma
so long-term antibiotic therapy (6-8 weeks) may be helpful in some cases.
Some alternative treatments have been used which include radiation therapy,
surgical excision of the lesion, cryotherapy (freezing), or intralesional injection
of a long acting corticosteroid. The success rate is very varied and improvement
is reported in 20-40% of the cases. These approaches are rather radical and
usually employed when other methods fail to be successful.
What is the prognosis?
Lick granuloma is a difficult condition to treat successfully. It is frustrating
because the cause is rarely identified and there is a strong psychological component
to this condition. Remember that the initial course of treatment may be unsuccessful
and that other avenues can be pursued once a lack of response has been observed.
The trial and error approach, although tiresome, will usually ultimately result
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