Dog Health: Lick Granuloma

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     Obsessive Compulsive Disorders, (OCD) includes a group of abnormal behaviors that occur as a reaction to stress. Dogs react to stress in different ways which varies depending on their personality just like people do.

Some dogs focus on a certain area of their body continuously and lick it causing a lesion called a Lick Granuloma.

A lick granuloma is also referred to as an Acral Lick Granuloma. It is a self-inflicted circular skin lesion usually located on the lower third of the front or hind leg, just above the paw. The area involved is always one that the dog can reach by licking.

The exact cause is not known but stress seems to trigger the behavior. Sources of stress for dogs include:

a. Boredom and loneliness
b. Changes in their home, such as: the addition or loss of a family member or pet, or a new house guest.
c. Changes in daily routine affect dogs. For example, the holidays cause anxiety for a lot of dogs and owners.
d. Moving to a new house can also be traumatic.

DIAGNOSIS OF LICK GRANULOMA

Your vet must rule out all medical conditions because these signs can be caused by an underlying problem.

WHAT YOU AND YOUR VET CAN DO ABOUT LICK GRANULOMA

Therapy involves:

1. Identify and treat the underlying cause in which case the lesion usually resolves.
2. Remove or reduce the source of stress.

Eliminate underlying causes which may include:

1. Lick granulomas can occur secondary to pain from an arthritic knee or ankle. Discomfort from an old fracture that healed poorly can also act as a stimulus for licking.

2. A foreign body such as a thistle spine or splinter could provoke a reaction that draws the dog's attention to that particular spot and elicits a licking response.

3. Thyroid Disease resulting in low levels of thyroid hormone can be an underlying cause. Blood tests confirm low thyroid hormone levels and oral supplementation with thyroid hormone effectively resolves most lesions in these cases. Certain breeds are predisposed to Thyroid Disease.

4. Lick granulomas can also occur secondary to allergies. For example, allergic inhalant dermatitis results in inflamed, uncomfortable itchy skin, which may trigger the dog to begin licking. In this case, appropriate treatment for the allergy usually resolves the problem. Allergy testing is a valid consideration in these cases.

TREATMENTS FOR LICK GRANULOMA

A wide variety of topical preparations are used that usually do not resolve the problem.
Antibiotics are often used for 3 weeks or longer.
The best long-term resolution of this problem is usually a combination of medication and behavioral modification, which involves consulting a behavioral specialist and often also involves the use of anti-anxiety medications.

ANTI-ANXIETY MEDICATIONS

Amitriptyline - helps about one-third of dogs. It takes 4 weeks on medication to see if there will be an effect. If the medication helps, you can use as needed. Approximate cost for one month of treatment for a 75 pound dog = $15.00.

Prozac - helpful for 50% of dogs that lick. It is given for 4 weeks. If no response is seen, the dose is doubled for another 4 weeks and then stopped if the lesions heal. Approximate cost for a 75 pound dog = $135.00.

Naltrexone - helpful in 50-60% of cases. The pet takes the medication for only one month. If licking stops, it usually is stopped for weeks to months. Should licking resume, another course of medication may be instituted. Approximate cost for one month of treatment for a 50 pound dog = $210.00.

TIP: Clean lesions daily with iodine-based solutions, rinse well with water and pat dry. Blotting with alcohol helps dry out the lesion.

WHAT YOU AND YOUR VET CAN DO

Identify and treat the primary cause. Symptomatic treatments consist of topical antibiotic ointments, cortisone creams, and/or topical anesthetic preparations. Injections of Cortisone into these granulomas usually causes them to resolve but sooner or later most dogs start licking again.

Dogs with psychological disorders may respond to simple changes in environment geared to reduce stress and prevent boredom. Anti-anxiety drugs like Prozac have been advocated and acupuncture is also an effective alternative in certain cases. Stress and anxiety management plus medical intervention is the best choice for most cases.

COMPLEMENTARY TREATMENTS

Apply a solution of plantain (Plantago major) to the lesion. Preparation involves adding the leaves of the plantain plant to one cup of water. Boil for five minutes then let stand for five minutes or until cool. Use cheesecloth to strain out the solution. Apply the solution topically twice a day or as needed.

HOMEOPATHIC REMEDIES

Arsenica album 30c helps reduce constant chewing and licking. Give one pellet every four hours for three treatments. Rescue Remedy, three drops, three to four times daily, given by mouth or added to the water bowl has a calming effect.

TIP: Hops, Skullcap, Valerian Root, and Passion Flower help to reduce anxiety.

FACT: Acupuncture - is effective in some dogs.