Acral Lick Granulomas
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.
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.
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.
lesions are thought to be due to stress or boredom in some dogs
and even to be an obsessive/compulsive disorder in others.
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 anesthestic
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.
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.
really desperate situations, radiation therapy, casts over the
area, cryosurgery, and surgical excision have all been attempted.
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.