Acral Lick Granulomas
Acral lick granulomas are a common problem in dogs. There are a
number of treatments that have been advocated for this problem,
mostly because none of them is consistently successful in
eliminating all cases of lick granuloma.
Lick granulomas can occur secondary to allergies -- in this case,
treatment for the allergy is often successful. It is a good idea to
consider allergy testing in dogs with persistent lick granulomas or
recurrent ones. The standard treatments for allergies are itch
control medications or hyposensitizing "allergy shots". Skin testing
is the most accurate way to diagnose allergies. Veterinary
dermatologists frequently do this. Blood testing for allergies is
considered to be less accurate but can be substituted when skin
testing is hard to arrange.
Acral lick granulomas can occur secondary to injuries, underlying
bone infection (this is a tricky diagnosis because the persistent
licking can lead to periosteal inflammation around the bone making
it seem like an infection was the cause), bacterial skin infection,
parasites and other physical causes.
These lesions are thought to be due to stress or boredom in some
dogs and even to be an obsessive/compulsive disorder in others.
So the first step in treatment is to do a thorough examination for
an underlying cause. If one can be identified, it should be treated.
If a bacterial infection is suspected antibiotics must be used for
at least 6 to 8 weeks. If an underlying cause can not be found then
the lick granuloma itself should be treated.
There are a number of ways of doing this. Topical treatment with a
combination of Synotic and Banamine has been advocated. Local
anaesthetic preparations like DermaCool or Relief can be helpful.
Application of aversives like bitter apple or chloramphenicol
ophthalmic ointment is sometimes done. Bandaging or using a sock to
cover the lesion helps in some cases. A good adjunct to this type of
therapy appears to be administration of hydrocodone to cut down on
the irritation and/or fill the need for endorphins that the dog may
be experiencing.
The psychological cases can respond to simple changes in environment
(reducing stress or boredom). In more difficult cases,
amitriptyline (Elavil), naltrexone (Trexane), clomipramine
(Anafranil) and fluoxetine (Prozac) have been advocated. Acupuncture
is reported to work well in some dogs, anecdotally.
For really desperate situations, radiation therapy, casts over the
area, cryosurgery, and surgical excision have all been attempted.
This condition is frustrating and often will take several approaches
to find the one that will work. Keep working with your vet to find a
solution to the problem for your dog.
