Sadly, Acral Lick Granulomas, while easy to diagnose, can be really hard to manage. In this blog, we’re going to look at this horrible and frustrating condition, its causes, and appearance, and then explore some of the management options.
What is a lick granuloma?
Also known as an Acral Lick Granuloma, it’s a skin lesion that is not just worsened, but actually caused by chronic, excessive licking of a specific part of the body. The trouble is that the more the dog licks it, the worse the itching gets – this is called the “Itch-Scratch Cycle”.
What does it look like?
These usually look like a bald, thickened, reddened area of skin. Typically, they’re found on the upper surface of the front legs, although they can turn up anywhere. Sometimes the surface may seem dry, but usually they are a bit oozy, and they may smell nasty too. They are itchy and/or painful to the touch, so do be careful when looking at or checking them!
So what causes them?
Ultimately, there are three possible underlying causes:
- Pruritis – any cause of itching in or on the skin may trigger a lick granuloma. In dogs, common causes of itching include:
- Skin allergies (which may include pollen allergies, contact allergies and food allergies, or diseases such as Atopic Dermatitis).
- Parasites (e.g. fleas, lice, or mange mites).
- Bacterial or fungal skin infections.
- Some types of tumours, e.g. Mast Cell Tumours.
- Pain – dogs often lick painful areas; in time, this may develop into a lick granuloma. Well-recognised causes include:
- Wounds (although by the time the lick granuloma is recognised, the wound or grass seed or whatever may well have healed!)
- Nerve damage.
- Behavioural Problems – some behavioural issue that the dog tries to cope with by licking themselves. This is only rarely the initial underlying problem, but it is not uncommon for one of the above issues to trigger the licking, and then the dog develop a “licking-problem” as a result.
Whatever the cause, the process is the same – constant licking removes the hair and damages the skin, introducing bacteria (so lick granulomas are often infected, but usually infection is secondary). It also reduces the itching and discomfort immediately (which is why they do it), but then worsens it in the medium-term (hence the Itch-Scratch Cycle).
OK, but how can they be managed?
Ultimately, that depends on the underlying cause! The basic principles of management, though, are well established – it’s just the detail of actually doing it that’s tricky.
- Discover and resolve the underlying cause
No matter how good your management of the granuloma itself, unless we can work out why it’s happened, it’s going to keep on happening!
If itching is the underlying issue, then we’ll need to investigate the possible causes – are there parasites present? Does the dog have an allergy to something? Are they atopic? If not, we’ll look for causes of pain – are there any signs of arthritis? Do X-rays show any damage or changes to the bone in that area? Are there any wounds or foreign bodies in the leg (and not just under the granuloma – it could be somewhere else!). If everything else is negative, there are two possibilities – either the initial cause is gone and the granuloma is causing the itching (which is very likely), or the dog has a behavioural issue (which is also quite plausible). In severe cases of behavioural licking, it is often necessary to get a referral to a canine behavioural specialist, who will be able to work with you and your dog to resolve the behavioural aspects of the problem – but this is usually needed alongside, rather than instead of, medical treatment.
Once the cause has been identified, we can start to treat it – and while that may not clear up this lick granuloma on its own, it will at least allow other treatment options the chance to work!
- Treat the secondary infections
Bacteria in the skin are always a problem – itchy and potentially dangerous. Unfortunately, many of the bacteria cultured from lick granulomas are multi-resistant to antibiotics, so we usually need to culture them to see exactly what we’re fighting. Many affected dogs will need both topical (creams or ointments) and systemic (tablets or injections) antibiotics.
- Break the itch-scratch cycle
As long as the dog keeps licking, the granuloma won’t go away. There are a number of possible approaches, and what works best varies from dog to dog and case to case. In many cases, the use of anti-itching drugs (like steroids), either as as spray or cream, or systemically as an injection or tablets, is invaluable.
Bitter tasting bandages or sprays may also discourage licking, but in many cases, an Elizabethan Collar (or “Cone of Shame”) is needed to physically stop them from licking while the skin has a chance to heal.
We are very lucky that one of our vets, Nicky Shaw, has a special interest in all things related to the skin. So if you are worried about any skin problem then booking an appointment with Nicky at our Kings Avenue may help. Nicky is one of the few vets in the South West who has achieved a Royal College certificate linked to veterinary dermatology and holds the title of Advanced Practitioner in Veterinary Dermatology – only one of two vets in Cornwall to have achieved this special status.
If you do need to see Nicky then she will see you in an extended appointment lasting around about 45 minutes. This will mean that she can spend plenty of time with you and your pet working towards finding the root cause of the skin problem.
Please contact the surgery at Kings Avenue or speak to your regular vet that you see with us and chat about booking a special skin appointment with Dr Nicky Shaw, BVSc CertAVP(VD) MRCVS.