Acral Lick Dermatitis
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A lick granuloma, also known as acral lick dermatitis, is a
skin disorder A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, Nail (anatomy), nails, and related muscle and glands. The major funct ...
found most commonly in
dog The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the gray wolf. Also called the domestic dog, it was selectively bred from a population of wolves during the Late Pleistocene by hunter-gatherers. ...
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 injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals. Types There is no de ...
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, usually fixed to a wall or other vertical surface, meant to mark an event, person, etc. * Memorial Plaque (medallion), issued to next-of-kin of dead British military p ...
, 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, caregive ...
, 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 peptides produced in the brain that block the perception of pain and increase feelings of wellbeing. They are produced and stored in the pituitary gland of the brain. Endorphins are endogeno ...
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 coug ...
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 A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, Nail (anatomy), nails, and related muscle and glands. The major funct ...
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 Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provi ...
) 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 injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals. Types There is no de ...
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, also known as the dark spots or circles on the skin, is the darkening of an area of Human skin, skin or nail (anatomy), nails caused by increased melanin. Causes Hyperpigmentation can be caused by sun damage, inflammation, or ...
to that area. Lick granulomas sometimes become infected with
bacteria Bacteria (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...
, 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, caregive ...
, 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 (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...
l or
fungal A fungus (: fungi , , , or ; 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 one of the tradit ...
infections,
ectoparasites Parasitism is a close relationship between species, where one organism, the parasite, lives (at least some of the time) on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The en ...
,
metabolic Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the ...
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 coug ...
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 behavior Compulsive behavior (or compulsion) is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal ...
s in dogs. Drugs may be used until behavior modification has had time to take effect.
Antidepressant Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include Xerostomia, dry mouth, weight gain, dizziness, headaches, akathi ...
s are most commonly used, including
doxepin Doxepin is a medication belonging to the tricyclic antidepressant (TCA) class of drugs used to treat major depressive disorder, anxiety disorders, chronic hives, and insomnia. For label updates seFDA index page for NDA 022036/ref> For hives it ...
,
amitriptyline Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat major depressive disorder, and a variety of pain syndromes such as neuropathic pain, fibromyalgia, migraine and tension headac ...
,
fluoxetine Fluoxetine, sold under the brand name Prozac, among others, is an Antidepressant, antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used for the treatment of major depressive disorder, Anxiety disorder, anx ...
, and
clomipramine Clomipramine, sold under the brand name Anafranil among others, is a tricyclic antidepressant (TCA). It is used in the treatment of various conditions, most notably obsessive–compulsive disorder but also many other disorders, including hyper ...
. 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 use or opioid use disorder by reducing cravings and feelings of euphoria associated with substance use disorder. It has also been ...
can be used to reduce addiction to licking, or endorphin substitutes such as
hydrocodone Hydrocodone, also known as dihydrocodeinone, is a semi-synthetic 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 fo ...
may decrease the urge to lick. The animal should be tested for allergies, and treated accordingly if positive (
fatty acid In chemistry, in particular in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated and unsaturated compounds#Organic chemistry, saturated or unsaturated. Most naturally occurring fatty acids have an ...
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 provides ...
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 a butterfly-shaped gland located in the neck below the Adam's apple. It consists of two connected lobes. The lower two thirds of the lobes are connected by ...
levels, as
hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...
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, buster collar, pet ruff or pet cone (sometimes humorously called a treat funnel, lamp-shade, radar dish, dog-saver, collar cone, or cone of shame) is a protective medical device worn by an animal, usually a cat ...
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 surface area, body surfaces such as the skin or mucous membranes to treat ailments via a large ...
s such as
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
s or
DMSO Dimethyl sulfoxide (DMSO) is an organosulfur compound with the formula . This colorless liquid is the sulfoxide most widely used commercially. It is an important polar aprotic solvent that dissolves both polar and nonpolar compounds and is ...
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 chronic obstructive pulmonary disease (COPD). It can be taken in variou ...
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 at high doses durin ...
. Oral
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
s 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 (with ''cryo'' from the Ancient Greek ) is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. Cryosurgery has been historically used to treat a number o ...
,
laser surgery Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel. Soft-tissue laser surgery is used in a variety of applications in humans ( general surgery, neurosurgery, ENT, dentistry, orthodontics, and ...
,
radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...
, 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 and other
bird dog Pointing dogs, sometimes called bird dogs, are a type of gundog typically used in finding game. Gundogs are traditionally divided into three classes: retrievers, flushing dogs, and pointing breeds. The name ''pointer'' comes from the dog's insti ...
s. Most of the dogs with the condition are over five years of age. *
Airedale Terrier The Airedale Terrier (often shortened to "Airedale"), also called Bingley Terrier and Waterside Terrier, is a dog breed of the terrier type that originated in the valley (''dale'') of the River Aire, in the West Riding of Yorkshire, England. It ...
*
Boxer Boxer most commonly refers to: *Boxer (boxing), a competitor in the sport of boxing * Boxer (dog), a breed of dog Boxer or boxers may also refer to: Animal kingdom * Boxer crab * Boxer shrimp, a small group of decapod crustaceans * Boxer snipe ee ...
*
Doberman The Dobermann is a German breed of medium-large working dog of pinscher type. It was originally bred in Thuringia in about 1890 by Louis Dobermann, a tax collector.
* Golden Retriever *
Great Dane The Great Dane is a German list of dog breeds, breed of large mastiff-sighthound, which descends from hunting dogs of the Middle Ages used to hunt bears, wild boar, and deer. They were also used as guardian dogs of German nobility. It is one o ...
*
Irish Setter The Irish Setter (, literally "red setter") is a setter, a breed of gundog, and family dog originating in Ireland. The term ''Irish Setter'' is commonly used to encompass the show-bred dog recognised by the American Kennel Club as well a ...
*
Labrador Retriever The Labrador Retriever or simply Labrador or Lab is a British list of dog breeds, breed of water dog retriever gun dog. It was developed in the United Kingdom from St. John's water dogs imported from the Newfoundland Colony, colony of Newfoun ...
*
Weimaraner The is a German breed of hunting dog of medium to large size, with history going back at least to the nineteenth century. It originated in the area of the city of Weimar (then in Saxe-Weimar-Eisenach, now in the state of Thuringia), for which ...


References


External links

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