acrallick

Canine Acral Lick Granuloma

A Dermatological Nightmare
What is Acral Lick Dermatitis
Lick Granuloma

Acral Lick Granuloma... A Dermatology Nightmare

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The photos below are classic examples of an Acral Lick Granuloma (Lick Granuloma). Click on the photo to see the full sized photo. There is a good case history on this page below about Lick Granulomas.

ac·ral adj. Of, relating to, or affecting peripheral parts, such as limbs, fingers, or ears

Everyone who has had a dog with a lick granuloma will tell the same story. The skin lesion started as a tiny sore spot on the skin and the dog kept licking at it. Applying medications didn't seem to help much and the darn thing kept spreading outward lick1small

while thickening. It often would be wet and oozing from the dog licking and chewing incessantly at it. Finally a lick2small

trip to the veterinarian revealed a name for this patch of thickened, scarred and irritated skin: ACRAL LICK GRANULOMA! "Well, OK", the owner would say, "so what do we do about it?"

The problem is that we veterinarians cannot give the owner a specific recipe for a cure for acral lick granuloma. The skin is so deeply affected that even down to the base layer of the skin there can be found under the microscope little pockets of bacteria, broken hair follicles, plugged and scarred oil glands and dilated and inflamed capillaries. And if these skin lesions are removed surgically, the dog simply licks at the sutures or incision line after the surgery heals, thus creating a brand new granuloma right where the original one was!

The photos above to the left and right are of an Airedale with a classic case of Lick Granuloma. (Click on the photos to see a larger version in a new window.) The dog is perfectly healthy, is on an excellent diet, does not suffer from allergies but does have slight separation anxiety when his owner leaves for work. In this case the "cause" of the licking specifically at the affected area of skin may be self stimulation to help allay the anxiety of separation from the owner. The skin lesions will heal slightly, almost seem like they are going to heal, and overnight (or during the day while left alone) the lick granuloma is activated, licked raw from continuous passes of the tongue. Also with this dog, when one of the attempts to break the cycle of licking involved wrapping the lower leg with a cast to keep the dog away from the lesion, he began to make a new one in the same location on the opposite leg! Now there are TWO LICK GRANULOMAS!

Breeds most likely to have a Lick granuloma
Doberman Pinscher	German Shepherd	Golden Retriever
Labrador Retriever	Irish Setter	Weimaraner
Lick granulomas are almost always located on the front of the wrist area (carpal area) or on the front or outside of the rear leg just above the paw. Acral lick granulomas are thick, hairless, scarred and deeply infected sores that often have ulcerated and oozing centers as a result of continuous, compulsive licking and infection.

CAUSES:

There are numerous theories and one may apply for one dog and an entirely different theory may be correct for another. Take your pick...

1.)   Many dermatologists think that boredom is a major underlying factor in some cases of Acral Lick Granuloma. The dog's licking activity helps pass the time.
2.)   Some believe that allergic inhalant dermatitis creates stress in the skin resulting in inflammation and pruritus (itching) which triggers the dog's propensity to lick at any convenient area.
3.)   A foreign body such as a thistle spine, splinter or bee sting might start up a reaction in the skin which leads to drawing the dog's attention to the spot.
4.)   Bone or joint pain can draw the dog's attention to the wrist or ankle area and in an attempt to alleviate the discomfort the dog licks over the top of the joint.
5.)   Psychological stimuli such as separation anxiety, a new pet or child in the home, or neighbor dogs invading the dog's "territory" can create psychological stress. Self stimulation such as picking out an area to concentrate on and licking for extended periods of time are a way for the dog to relieve the "stress".
6.)   Hypothyroidism has played a role in some cases of Acral Lick Granuloma.   Especially in Black Labs with lick granulomas it would be a good idea to have the Thyroid Gland function checked. Thyroid medication may just be what the dog needs to have those skin lesions resolve.

TREATMENTS:

NOTE: Lick granulomas and laser surgery...The use of laser surgical instrumentation is fast becoming a useful tool to assist in treatment of lick granulomas in dogs. The laser instrument ablates (removes) the tissue by vaporizing the surface layers. As the laser light energy passes over the diseased tissue it is essentially vaporized, nerve tissue is sealed so that little sensation is perceived by the patient, and bleeding from the surgical area is minimal. Your veterinarian may have laser surgery or may refer you to a veterinarian who does so that a consultation specific for your dog's problem can be arranged.

Numerous methods have been tried in an effort to stimulate healing and resolution of acral lick granulomas in dogs. Some therapy is directed at attempts to keep the dog away from the skin lesion in order to allow it to heal. The truth is that methods work very well. Such things as bandaging the entire leg (the dog will lick just above any wrap or cast that is placed over the lickgransmall

lesion) and applying nasty tasting materials such as Bitter Apple or Tabasco sauce, usually to no avail. Barbed wire wrapped in plaster casts doesn't work. Putting an Elizabethan collar on doesn't work well because as soon as it is removed the licking starts again and the dog will activate the lesion all over again. The bottom line is that these chronic, infected, ulcerated skin lesions are often the result of a psychological compulsion to lick and chew at this target area.

Obsessive and compulsive disorders do occur in dogs and these lick granulomas can therefore persist for years and years. Psychogenic and anti-anxiety drugs have been tried, too. Very occasionally such medications as Prozac or Xanax might make a slight difference...but not enough dogs respond well to these to be able to call psychoactive medications a cure. Cortisone injections into and under the granuloma quiet them down, alleviate pruritus (itchiness) and shrink them...for a while; then the dog starts licking again and the lesion becomes as big as ever. Deadening cutaneous nerves has been tried, even Cobra venom was professed to have a cure rate of 90% way back in the early 1970s, but these methods have proven to be unsatisfactory.

We've got a real dermatology nightmare here! Something makes the dog compulsively attracted to the granuloma and they often will start licking at a different place if the dog is prevented from licking at the original lesion! Look at the photo above on the right and you can see the second lesion on the opposite leg that this dog started when he was put into a cast to inhibit the licking at the first lesion.

So...what does on do about this nightmare? Long term antibiotics seem to be the best helper...as long as three to six months may be required for significant improvement. Cortisone topical creams rubbed into the lesion daily can help. Topical medications that have multiple antibiotic/cortisone ingredients can help. This is one disorder where the veterinarian preaches control or management of the skin problem since a cure is not now known. Any little thorn, splinter, tick bite, scratch or infection over the carpal areas in the front legs and over the area lower down from the tarsus in the rear legs can lead in a short time to an Acral Lick Granuloma. So keep a close eye on these problem spots and at the first sign of persistent licking at one particular site, get veterinary help as soon as possible.

Many types of dermatological problems are avoided if the dog or cat is consuming an optimum diet... see the Important Topics DermCaps , a popular Omega Fatty Acid supplement with a number of beneficial ingredients, is the key factor in avoiding repeated episodes of Hot Spots and other skin afflictions. If your dog or cat seems to lack good coat and skin health, consider upgrading the diet to a meat-based ingredient formula and adding a supplement such as omega fatty acids

department in ThePetCenter.com for lots of nutritional information about nutrition for dogs and cats. In some cases, adding a supplement such as can make a very real difference.

LICK GRANULOMA IN A DOG... A CASE PRESENTATION:

BEFORE THERAPY

AFTER THERAPY


Click to see closeup view


Click to see closeup view

Three months ago acral lick granulomas on Nikki, my Rhodesian Ridgeback bitch, were very distressing and I was rather desperate to help her. I decided to take her to Dr. Daniel Morris who is head of Dermatology at the Veterinary Hospital of the University of Pennsylvania. Dr. Morris examined Nikki and she has been placed on 2000 mg of Cephalexin (biopsy showed deep follicular infection, not *MRSA) for 5 weeks now, and steroids. The steroids were started at 20mg day and is now now on a tapering off schedule. We plan on continuing antibiotics for 12 weeks and the steroids will be reduced to the lowest dose without reoccurrence of itchiness or licking. She was also recently started on hyposensitization shots based on her Heska Company allergy testing results.
She's had the best couple of weeks in a very long time. Less pruritic, more energy, overall happier, and as you can see from the attached pictures, some healing is taking place. We expect to keep the lick granulomas under control but understand that a total cure may not be possible. I will keep ThePetCenter.com updated regarding her progress.
Donna Knitter RRT, CPFT, CVT

* The term MRSA or methicillin resistant Staphylococcus aureus is used to describe those examples of this organism that are resistant to commonly used antibiotics. Methicillin was an antibiotic used many years ago to treat patients with Staphylococcus aureus infections. It is now no longer used except as a means of identifying this particular type of antibiotic resistance.

Similar articles of interest...
Itch and Scratch	Sarcoptic Mites	Demodex Skin Mites	Nutrition

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What is acral lick dermatitis?

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This is a complex disorder in which dogs lick continuously at an area on their leg , which becomes raw, weeping, and ulcerated. The cause is unknown but inheritance may play a role, since certain breeds are affected more commonly. Boredom or frustration are considered contributing factors. Other possibilities include a disorder of the sensory nerves, or an obsessive-compulsive disorder.

How is acral lick dermatitis inherited?
No mode of inheritance has been established.

What breeds are affected by acral lick dermatitis?
The following breeds are more commonly affected than others: Doberman pinscher, German shepherd, Great Dane, Irish setter, Labrador retriever.

For many breeds and many disorders, the studies to determine the mode of inheritance or the frequency in the breed have not been carried out, or are inconclusive. We have listed breeds for which there is a consensus among those investigating in this field and among veterinary practitioners, that the condition is significant in this breed.

What does acral lick dermatitis mean to your dog & you?
Owners are generally amazed by the amount of damage a dog can do to his/her limb simply by continuous licking. Frequently the affected area becomes secondarily infected (pyoderma).

Boredom and frustration are thought to play a role in this condition, which is often seen in highly intelligent dogs who spend much of their day alone.

How is acral lick dermatitis diagnosed?
It is important to rule out any underlying cause of the condition. Your veterinarian will likely do a skin biopsy for this purpose. This is a simple procedure, done with local anesthetic, in which your veterinarian removes a small sample of your dog's skin for examination by a veterinary pathologist.

For the veterinarian: Rule-outs include neoplasia, pressure point granulomas,various infectious agents, underlying sensitivities, allergies, histiocytomas, mastocytomas.

How is acral lick dermatitis treated?
Lick granulomas can be difficult for veterinarians to treat, and frustrating for the owner. Because boredom and frustration are thought to play a role in this condition, your veterinarian will likely discuss with you environmental enrichment and behaviour modification for your dog. S/he may prescribe certain drugs with anti-depressant or anti-anxiety properties for short periods, relying on your help in assessing the effects. Topical corticosteroids may help as well.

As the area is frequently secondarily affected, anti-bacterial therapy may be necessary.

Breeding advice
Because inheritance appears to play a role in this complex condition, it is preferable not to breed dogs in whom acral lick dermatitis is a problem.

FOR MORE INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.

Copyright © 1998 Canine Inherited Disorders Database. All rights reserved.
This database is funded jointly by the Sir James Dunn Animal Welfare Centre at the Atlantic Veterinary College, University of Prince Edward Island, and the Canadian Veterinary Medical Association.
Permission to reprint is granted by
Alice Crook, DVM Coordinator, Sir James Dunn Animal Welfare Centre
Atlantic Veterinary College University of Prince Edward Island

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VP Client Information Sheets

By VIN Community Contributors
http://www.veterinarypartner.com

Lick Granuloma

Becky Lundgren, DVM

Lick granuloma (acral lick granuloma, acral lick dermatitis) is a common, stubborn skin disease that is directly caused by the dog licking an area of the body, usually the lower leg. Lick granulomas may be mistaken for neoplasms and foreign body granulomas.

Causes include:

Atopy
Boredom
Flea bite sensitivity
Food allergy
Hypersensitivity
Neoplasia
Emotional/Behavioral problems
Staphylococcal furunculosis
Wounds

Both males and females can have lick granulomas, but males have a higher incidence. Any age dog can be affected, but mature or old dogs are more commonly affected. Breeds commonly affected include (but are not limited to): Doberman pinscher. German shepherd, German short haired pointer, Golden retriever, Great Dane, Irish setter, Labrador retriever, and Pointer.

Signs include hair discoloration, hair loss, skin sores, hyperplasia (an abnormal increase in the number of normal cells), fibrosis (formation of fibrous skin and tissue similar to gristle), lameness caused by the mass, and growth of the underlying bone. The lesions are usually solitary, but they can occur on more than one limb at the same time. The areas most frequently affected are the front and sides of the lower legs. In rare cases, lick granulomas can occur in the flank or at the base of the tail.

Diagnosis
During a physical examination, the veterinarian sees a thick dermal plaque. The spot does not have hair and is inflamed on an extremity that the dog is constantly licking. Sometimes a biopsy is taken.

Treatment
Treatments include:

1) Treating the inciting cause
2) Identifying and correcting the psychogenic causes by increasing the amount of human contact, changing kenneling habits, providing other animal companionship, and distracting with chew toys.
3) Medical treatment options include sedatives/tranquilizers, endorphin blockers, corticosteroids, antidepressants, or pentoxifylline.
4) Surgical removal of the lesion
5) Radiation therapy
6) Bandaging
7) Applying bad-tasting substances to the granuloma

NOTE: No treatment is uniformly successful. This disease is hard to control or cure. Many different methods may need to be tried when attempting to control this problem.

Copyright 2003 - 2007 by the Veterinary Information Network
This work was originally published by Veterinary Information
Network, Inc. (VIN) and is republished with VIN's permission.

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The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.