What is a lick granuloma?
Also known as acral lick dermatitis, this problem occurs when a dog obsessively licks at an area on the lower limb, most commonly the wrist or carpal joint of the front limb. This condition is thought to be both physical and psychological in nature. However, there is a definite strong psychological component (e.g., fear, anxiety, or obsessive-compulsive disorder). These dogs find a spot to lick and start a cycle of self-trauma, inflammation, and infection. (Image via Wikimedia Commons / Joel Mills (CC BY-SA 3.0.)
Is there any breed disposition?
The condition occurs mainly in medium to large breeds, particularly Doberman Pinschers, Great Danes, Labrador Retrievers, Golden Retrievers and Irish Setters. However, it is important to remember that any breed may develop acral lick dermatitis.
What is the cause?
The exact cause of acral lick dermatitis is unknown. However, it is believed to be caused by multiple factors including both physical (e.g., allergies, infection, joint pain) and psychological (e.g., fear, anxiety, obsessive-compulsive disorder).
In some cases, the licking may even start because of a minor irritant such as an insect sting. It should be noted that although it can occur on the hind limbs, the top and outside surfaces of the forelimbs (front legs) are most commonly affected. These are areas that the dog can constantly lick while lying in a normal position. It is important to distinguish between psychological and physical causes in order to provide the proper treatment. These lesions can often be chronic relapsing problems that require long-term therapy.
How is it diagnosed?
The location and appearance of the lesion is a major guide to diagnosis. Your veterinarian may recommend radiographs (X-ryas) of the underlying joint to determine if arthritis is present. Skin biopsies may be necessary if there is no response to treatment, or to rule out other causes such as mange or a tumor.
What is the treatment?
The treatment will vary depending on your pet's condition. Identifying the underlying cause is important in determining the best course of treatment. Most dogs require treatment aimed at the inflammation, infection, and psychological components for resolution. Topical and oral anti-inflammatory medications such as corticosteroids are helpful in reducing inflammation. Psychopharmacologic medications may be needed to reduce anxiety and obsessive-compulsive disorders. Antibiotics are often required to treat secondary skin infections.
"Identifying the underlying cause is important in determining the best course of treatment."
Since the root cause is often related to anxiety or boredom, increasing interaction and stimulation are often strongly recommended. While the condition can be frustrating to get under control, most cases of acral lick granuloma can be successfully treated if the owner is willing to pursue extended tests and treatments.