Etiology (Causes)

• Chronic Licking: Acral lick granulomas develop from continuous, compulsive licking, causing skin damage and inflammation.

• Infections: Bacterial, yeast, or fungal infections can trigger or worsen the condition.

• Allergies: Flea allergies, food sensitivities, or environmental allergens are common contributors.

• Ectoparasites: Mites or other parasites can lead to irritation and subsequent licking.

• Joint Issues: Arthritis or previous injuries may cause discomfort that leads to licking.

• Neurological Factors: Nerve-related issues (e.g., nerve tumors or entrapment) can contribute to compulsive licking.

• Metabolic Disorders: Conditions like hypothyroidism or Cushing's disease may predispose dogs to licking behaviors.

• Stress and Anxiety: Emotional triggers like stress, boredom, or separation anxiety can exacerbate licking.

• Neoplastic Disease: Rarely, cancerous growths can cause excessive licking behavior.

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Clinical Signs

• Location: Lick granulomas are most commonly found on the lower legs (front or hind) but can also appear on the flank or near the tail.

• Appearance: Initially, lesions are red, crusty, and may evolve into thickened, bald patches or nodules.

• Ulceration: The center often becomes ulcerated, red, moist, or scabbed over.

• Skin Changes: Over time, the skin may become hyperpigmented (darkened).

• Multiple Lesions: In some cases, dogs may have several lick granulomas at once.

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Diagnosis

• Patient History: Key questions include when the licking started, if it’s linked to specific triggers (time of day, stress, environmental changes), and any prior trauma or surgery.

• Physical Exam: The veterinarian will assess the lesion’s appearance and rule out other conditions.

• Skin Cytology: Cytology to check for bacteria, yeast, or fungal infections can provide initial clues.

• Fine-Needle Aspiration: Used to check for neoplastic disease in nodular lesions.

• Skin Scraping/Trichograms: To rule out demodicosis (mange).

• Fungal Testing: Cultures or PCR testing can identify dermatophyte infections.

• Biopsy: A skin biopsy for histopathology may confirm the diagnosis and uncover underlying causes.

• Radiographs: In cases where orthopedic issues are suspected, X-rays can help assess joint problems.

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Treatment and Prevention

• Antibiotics: Oral antibiotics for 2-3 months (or longer) to address secondary bacterial infections.

• Anti-inflammatory Medications: Steroids (oral, topical, or injectable) may be prescribed to reduce inflammation and itch. NSAIDs may be used for pain but should not be combined with steroids.

• Topical Treatments: Products like bitter apple or capsaicin can deter licking. These may be combined with physical barriers (e.g., E-collars or bandages) to prevent further licking.

• Surgical Intervention: In some cases, small lesions may be surgically removed, although recurrence is possible if the underlying cause isn’t addressed.

• Behavioral Therapy: Training, increased interaction with the dog, or even medication (e.g., fluoxetine or clomipramine) to address compulsive behaviors or anxiety.

• Laser Therapy: CO2 laser or cold laser therapy may aid in healing in select cases.

• Acupuncture: Some dogs may benefit from acupuncture around the affected area to reduce inflammation and promote healing.

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Prognosis

• Varied Prognosis: While acral lick granulomas are not life-threatening, they are challenging to treat and can be persistent.

• Chronic Cases: Dogs with long-term or severe conditions may face a guarded prognosis, requiring extensive treatment and owner commitment.

• Early Intervention: Dogs that receive treatment early on have a better chance of recovery.

• Recurrence: Even with successful treatment, the condition may recur if the underlying cause is not fully addressed.

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