Lick Granulamas... A Dermatology Nightmare

The photos below are classic examples of an Acral Lick Granuloma (Lick Granuloma).  Click on the photo to see the full sized photo.  There is a good discussion on this page about Lick Granulomas.

Everyone who has had a dog with a lick granuloma will tell the same story.  The skin lesion started as a tiny sore spot on the skin and the dog kept licking at it.  Applying medications didn't seem to help much and the darn thing kept spreading outward while thickening.  It often would be wet and oozing from the dog licking incessantly at it.

Finally a trip to the veterinarian revealed a name for this patch of thickened, scarred and irritated skin: ACRAL LICK GRANULOMA!   "Well, OK", the owner would say, "so what do we do about it?"

No veterinarian alive can give the owner a recipe for a cure for lick granuloma.  The skin is so deeply affected that even down to the base layer of the skin there can be found under the microscope little pockets of bacteria, broken hair follicles, plugged and scarred oil glands and dilated and inflamed capillaries.  And if these skin lesions are removed surgically, the dog simply licks at the sutures or incision line after the surgery heals and creates a brand new granuloma right where the original one was!

lick granuloma on the tarsusThe photos on this page are of an Airedale  with a classic case of Lick Granuloma.  [Click on the photo of the lick granuloma and a full sized photo will appear... then just hit your BACK  button to get back here.]  The dog is perfectly healthy, is on an excellent diet, does not suffer from allergies but does have slight separation anxiety when his owner leaves for work.  In this case the "cause" of the licking specifically at the affected area of skin may be self stimulation to help allay the anxiety of separation from the owner.  The skin lesions will heal slightly, almost seem like they are going to heal, and overnight (or during the day while left alone) the lick granuloma is activated, licked raw from continuous passes of the tongue.  Also with this dog, when one of the attempts to break the cycle of licking involved wrapping the lower leg with a cast to keep the dog away from the lesion, he began to make a new one in the same location on the opposite leg!  Now there're TWO LICK GRANULOMAS! (See the photo below.)  Well, that didn't work...

Breeds most likely to have a Lick granuloma

Doberman Pinscher German Shepherd Golden Retriever
Labrador Retriever Irish Setter Weimaraner

Lick granulomas are almost always located on the front of the wrist area (carpal area)  or on the front or outside of the rear leg just above the paw (tarsal area).  They are thick, hairless, scarred sores that have ulcerated and oozing centers as a result of continuous, compulsive licking.

CAUSES:

There are numerous theories and one may apply for one dog and an entirely different theory may be correct for another.  Take your pick...
1.)   Many dermatologists think that boredom is a major underlying factor in some cases of Acral Lick Granuloma.  The dog's licking activity helps pass the time.
2.)    Some believe that allergic inhalant dermatitis creates stress in the skin resulting in inflammation and pruritus (itching) which triggers the dog's propensity to lick at any convenient area. 
3.)  A foreign body such as a thistle spine, splinter or bee sting might start up a reaction in the skin which leads to drawing the dog's attention to the spot.
4.)  Bone or joint pain can draw the dog's attention to the wrist or ankle area and in an attempt to alleviate the discomfort the dog licks over the top of the joint.
5.)  Psychological stimuli such as separation anxiety, a new pet or child in the home, or neighbor dogs invading the dog's "territory" can create psychological stress.  Self stimulation such as picking out an area to concentrate on and licking for extended periods of time are a way for the dog to relieve the "stress".
6.)  Hypothyroidism has played a role in some cases of Acral Lick Granuloma.   Especially in Black Labs with lick granulomas it would be a good idea to have the Thyroid Gland function checked.  Thyroid medication may just be what the dog needs to have those skin lesions resolve.

Treatments:

Many, many trick and treats have been tried in an attempt to keep the dog away from the skin lesion in order to allow it to heal.  Ya know what?  None of 'em work very well.  Such things as bandaging the entire leg (the dog will lick just above any wrap or cast that is placed over the lesion) and applying nasty tasting stuff like Bitter Apple or Tabasco sauce doesn't work.   Barbed wire wrapped in plaster casts don't work.  Putting an Elizabethan collar on doesn't work well because as soon as it is removed the licking starts again and the dog will activate the lesion all over again.

Anti-anxiety drugs have been tried, too.  Very occasionally such medications as Prozac or Xanax might make a slight difference...but not enough dogs respond well to these to be able to call psychoactive medications a cure. Cortisone injections into and under the granuloma quiet them down and shrink them...for a while; then the dog starts licking again and the lesion becomes as big as ever.  Deadening cutaneous nerves has been tried, even Cobra venom was professed to have a cure rate of 90% way back in the early Seventies, and these methods have proven to be unsatisfactory.

Two Granulomas now!We've got a real dermatology nightmare here!  Something makes the dog compulsively attracted to the granuloma and will start licking at a different place if it cannot get at the original lesion.  Look at the photo on the right and you can see the second lesion on the opposite leg that this dog started when he was put into a cast to inhibit the licking at the first lesion.

So...what does on do about this nightmare?  Long term antibiotics seem to be the best helper...as long as three months may be required for significant improvement.  Cortisone topical creams rubbed into the lesion daily can help.  Topical medications that have multiple antibiotic/cortisone ingredients can help.  This is one disorder where the veterinarian preaches control or management of the skin problem since a cure is not now known.  Any little thorn, splinter, tick bite, scratch or infection over the wrist areas in the front legs and over the area lower down from the ankle in the rear legs can lead in a short time to an Acral Lick Granuloma.  So keep a close eye on these problem spots and at the first sign of persistent licking at one particular site, get some veterinary help as soon as possible.