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Acral Lick Dermatitis, Lick Granuloma
Acral lick dermatitis in dogs is one of the most common and frustrating dermatological problems encountered in general practice. The condition is now accepted as being a multifactorial disease, and attempts to manage it with a single treatment are usually doomed to failure.
Acral lick dermatitis, lick granuloma, or acral pruritic nodule is a single or multiple lesion on one or more extremities resulting from excessive and persistent licking. The exact cause is not known.
Many factors, or triggers, have been suggested to predispose to or cause acral lick dermatitis, including allergy (atopic dermatitis, food), psychogenic cases, boredom, bacterial folliculitis, foreign bodies, neuropathy, local trauma, and joint or bone diseases. Independent of the contributing factor, once the lesion has developed it will contribute to the perpetuation of the compulsive licking behavior.
Lesions are usually single but they can be multiple. Large breeds are predisposed (Doberman pincher, Labrador retriever, Dalmation, Irish setter, Weimaraner, German shepherd, Great dane). Onset of lesions can occur at any age, but it is more common in dogs more than 5 years of age. Lesions tend to be recurrent, either at the same or different sites. There is often a history of poor or partial response to many therapeutic treatments. Lesions are created and maintained by constant licking or chewing. Clinically the lesion is characterized by alopecic, red, eroded or ulcerated, firm, nodular plaque(s).
DIAGNOSIS Diagnosis of acral lick dermatitis is based on history, clinical signs, and elimination of other primary causes. It may include skin scrapings, impression smear cytology, and fungal culture (to rule out dermatophytosis). Biopsy of the lesion is helpful to rule out neoplasia (e.g. mast cell tumor). If joint or bone involvement is suspected, radiographs should be taken. If there is a history of intense itchiness pruritus (either seasonal or nonseasonal) an allergy test is performed.
TREATMENT Approximately 65% of the cases can be satisfactorily controlled with medical and/or behavior management. Even if an underlying problem has been identified and treated, concurrent treatment of the skin condition is essential. It is important to treat the frequently associated secondary bacterial infection with appropriate long-term (6 to 8 weeks) antibiotics. Treatment of this condition can be complicated, and in selected cases surgical removal of the affected area is indicated, particularly if the lesion is small, although complication may develop.
To stop the lick cycle device to prevent licking are recommended : elizabethan collar, bandaging, bad tasting topicals, basquet muzzle. The following drugs aimed to alliviate anxiety are used: phenobarbital, diazepam (Valium), hydroxyzine (Atarax); tricyclic antidepressants: amitriptyline (Elavil), imipramine (Tofranil), and Clomipramine (Anafranil).
The successful treatment of lick granulomas relies on a thorough investigation of potential underlying causes and a combination of treatments that may include systemic, topical, behavioral, and surgical methods.
PROGNOSIS In most cases a fair to guarded prognosis is given to dogs with acral lick dermatitis. If the underlying condition can be determined, the prognosis improves dramatically.
References
1. Nesbitt G.E. & Ackerman L.J. Miscellaneous Canine Skin Diseases. In: Canine and Feline Dermatology: Diagnosis and Treatment. Veterinary Learning Systems, Trenton, New Jersey
2. Reconstruction of a Nonhealing Lick Granuloma in a Dog Using a Phalangeal Fillet Technique
Jackie L. Demetriou, BVetMed, Diplomate ECVS, Christopher J. Shales, MAVetMB, Diplomate ECVS, MRCVS, Michael H. Hamilton, BVM & S, MRCVS and Thomas R. Sissener, DVM, MS, Diplomate ECVS
Go Pets America recommends seeking the advice of your local veterinarian for the most appropriate vaccination program and for the diagnosis and treatment of your pet's health problems. For vaccination requirements please contact your state and local licensing authorities.
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