Acral 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.

Lick 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.

Acral 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.

These lesions are thought to be due to stress or boredom in some dogs and even to be an obsessive/compulsive disorder in others.

So 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.

The 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.

For really desperate situations, radiation therapy, casts over the area, cryosurgery, and surgical excision have all been attempted.

This 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.

Mike Richards, DVM