HOME

TheInfoList



OR:

A lick granuloma, also known as acral lick dermatitis, is a skin disorder found most commonly in
dog The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...
s, but also in cats. In dogs, it results typically from the dog's urge to lick the lower portion of one of their legs. The
lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...
can initially be red, swollen, irritated, and bleeding, similar to a hot spot (wet eczema). The animal's incessant licking of the lesion eventually results in a thickened, firm, oval
plaque Plaque may refer to: Commemorations or awards * Commemorative plaque, a plate or tablet fixed to a wall to mark an event, person, etc. * Memorial Plaque (medallion), issued to next-of-kin of dead British military personnel after World War I * Pl ...
, which is the granuloma. A major cause of lick granuloma appears to be psychological, related to stress, anxiety,
separation anxiety Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment (e.g., a parent, caregiver, ...
, boredom, or compulsiveness. Lick granulomas are especially seen in active dogs left alone for long periods of time. One theory about the cause of lick granulomas is that excessive licking causes
endorphin Endorphins (contracted from endogenous morphine) are chemical signals in the brain that block the perception of pain and increase feelings of wellbeing. They are produced and stored in an area of the brain known as the pituitary gland. Hist ...
release, which reduces pain and makes the animal feel comfort temporarily. Other triggers include itchy skin, painful conditions caused by trauma to the skin, arthritis, neuralgia, and peripheral neuropathy. A bacterial or fungal infection of the skin can also trigger itching, as can skin mites, allergies, a reaction to an environmental irritant or toxin, hyperthyroidism, and certain types of cancer. Treatment of the primary cause, if known, is essential. In
psychogenic A psychogenic effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to: * Psychogenic pain *Psychogenic disease * Psychogenic amnesia *Psychogenic co ...
cases, psychological factors should be identified and addressed, such as being left alone all day, being confined, and changes in the household.


Signs and symptoms

Lick granuloma is a form of self-trauma and skin disorder in which most commonly dogs, but also cats, continuously lick a small area of their body until it becomes raw and inflamed. The most common areas affected are the lower ( distal) portions of their legs, such as the
carpus In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carpal ...
(wrist), or sometimes another part of their body such as the base of their tail. Seventy percent of the time it occurs on one of the dog's left legs. The
lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...
can initially be red, shiny, swollen, hairless, irritated, and bleeding, similar to a hot spot (wet eczema). Eventually, a raised hard plaque forms. Frequent formations of lick granulomas in the same area due to the constant licking will cause hardening, callous formation, hair loss (the hair may stop growing back), and
hyperpigmentation Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin. Causes Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris.James, William; Ber ...
to that area.   Lick granulomas sometimes become infected with
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typically a few micrometr ...
, causing abscessed areas or fistulous tracts (
furuncles A boil, also called a furuncle, is a deep folliculitis, which is an infection of the hair follicle. It is most commonly caused by infection by the bacterium ''Staphylococcus aureus'', resulting in a painful swollen area on the skin caused by an ...
).


Causes

Lick granulomas are caused by a variety of factors. One common cause of lick granulomas appears to be psychological, related to stress, anxiety,
separation anxiety Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment (e.g., a parent, caregiver, ...
, boredom, or compulsiveness. Lick granulomas are especially seen in large active dogs left alone for long periods of time. It is often considered to be a form of canine obsessive-compulsive disorder. Other causes include
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typically a few micrometr ...
l or
fungal A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from th ...
infections,
ectoparasites Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson ha ...
, metabolic disease,
neoplastic A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
disease, trauma causing nerve damage, allergies, or joint disease. Hot spots may also lead to the formation of lick granulomas. Arthritic and mobility problems in older dogs give them more time to lick and over-groom themselves. The condition becomes a vicious cycle – erosion of the skin from licking leads to pain and itching, which leads to more licking.


Treatment


Of primary cause

Treatment of the primary cause, if known, is essential. In
psychogenic A psychogenic effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to: * Psychogenic pain *Psychogenic disease * Psychogenic amnesia *Psychogenic co ...
cases, dealing with psychological factors is most important. Factors should be identified such as being left alone all day, being confined, and changes in the household. Correction of these causes may include increased walks, avoiding confinement, and more interaction in the home. Some veterinarians have proposed that diet can affect compulsive behaviors in dogs. Drugs may be used until
behavior modification Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement conti ...
has had time to take effect. Antidepressants are most commonly used, including doxepin,
amitriptyline Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat cyclic vomiting syndrome (CVS), major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgi ...
, fluoxetine, and clomipramine. If the psychological factors are not corrected, the pet will usually relapse after the drugs are discontinued. Endorphin blockers such as
naltrexone Naltrexone, sold under the brand name Revia among others, is a medication primarily used to manage alcohol or opioid use disorder by reducing cravings and feelings of euphoria associated with substance use disorder. It has also been foun ...
can be used to reduce addiction to licking, or endorphin substitutes such as
hydrocodone Hydrocodone, also known as dihydrocodeinone, is an opioid used to treat pain and as a cough suppressant. It is taken by mouth. Typically it is dispensed as the combination acetaminophen/hydrocodone or ibuprofen/hydrocodone for pain severe eno ...
may decrease the urge to lick. The animal should be tested for allergies, and treated accordingly if positive (
fatty acid In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...
s,
antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
s, hypoallergic diet, etc.). It may also be necessary to check
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thy ...
levels, as hypothyroidism seems to play a role in some cases, particularly in black Labrador retrievers; thyroid medication often will resolve the problem if it is due to hypothyroidism.


Of lesion

The lesion should also be treated. Class 4 infrared laser treatments have been used with much success, although it may take several treatments to achieve the desired outcome. Licking can be prevented by the use of
Elizabethan collar An Elizabethan collar, E collar or pet cone (sometimes humorously called a treat funnel, pet lamp-shade, pet radar dish, dog-saver, or cone of shame) is a protective medical device worn by an animal, usually a cat or dog. Shaped like a truncate ...
s, dog leggings, battery-enhanced wraps, bandages, anti-licking ointments (which are bad tasting), and anti-lick strips (which are either bad tasting or simply provide a barrier). It is important to catch lesions early and keep the animal from licking them to then reduce inflammation and development of a habit.
Topical medication A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
s such as corticosteroids or
DMSO Dimethyl sulfoxide (DMSO) is an organosulfur compound with the formula ( CH3)2. This colorless liquid is the sulfoxide most widely used commercially. It is an important polar aprotic solvent that dissolves both polar and nonpolar compounds ...
may be effective if used early. Small lesions may be injected with
triamcinolone Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection i ...
or
methylprednisolone Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used concomitantly at hig ...
. Oral antibiotics are used to control infection. Surgery may be performed to remove whole lesions, but there is risk of continued self-mutilation to the area afterwards. Other potential treatments include
cryosurgery Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) ("icy cold") and surgery (''cheirourgiki'' – χ� ...
,
laser surgery Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vapor ...
,
radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...
, and
acupuncture Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientif ...
. It is important to note that many dogs will lick at another leg, another area on the same leg, or someplace else, creating a new lick granuloma, if they are prevented from licking at the original one while it heals.


Success rate

Overall, lick granulomas are very difficult to treat, with control only being achieved in about 65 percent of cases. Some animals will continue to lick at the area despite the use of anti-lick ointments or sprays to deter them, for instance.


Commonly affected dog breeds

Many large breed dogs appear to be predisposed, as well as
golden retrievers The Golden Retriever is a Scottish breed of retriever dog of medium size. It is characterised by a gentle and affectionate nature and a striking golden coat. It is commonly kept as a pet and is among the most frequently registered breeds ...
and other bird dogs. Most of the dogs with the condition are over five years of age. * Airedale Terrier * Boxer *
Doberman The Dobermann (; ), or Doberman Pinscher in the United States and Canada, is a medium-large breed of domestic dog that was originally developed around 1890 by Louis Dobermann, a tax collector from Germany.Golden Retriever The Golden Retriever is a Scottish breed of retriever dog of medium size. It is characterised by a gentle and affectionate nature and a striking golden coat. It is commonly kept as a pet and is among the most frequently registered breeds ...
*
Great Dane The Great Dane is a large sized dog breed originating from Germany. The Great Dane descends from hunting dogs from the Middle Ages used to hunt wild boar and deer, and as guardians of German nobility. It is one of the largest breeds in the worl ...
*
Irish Setter The Irish Setter ( ga, sotar rua, literally "red setter") is a setter, a breed of gundog, and family dog. The term ''Irish Setter'' is commonly used to encompass the show-bred dog recognised by the American Kennel Club as well as the field-bred ...
* Labrador Retriever *
Weimaraner The Weimaraner ( ) is a large dog that was originally bred as a hunting dog in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear and deer. As the popularity of large game hunting began to ...


References


External links

{{Medical resources , DiseasesDB = , ICD10 = , ICD9 = , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = Dog diseases Cutaneous conditions Anxiety disorders Self-harm