Lick granulomas: An annoying little problem that is difficult to solve

If you’ve no idea what a lick granuloma is, count your blessings! What a nuisance they can be.  The official name for this disease is acral lick dermatitis.  “Acral” refers to an extremity (leg) and “dermatitis” means inflammation of the skin. The “lick” is thrown in because incessant licking behavior is what causes the problem.

Acral lick granulomas are skin sores that typically occur in large breed dogs (Doberman Pinchers and Labradors are notorious) and more males than females.  For reasons we truly don’t understand, affected dogs pick a spot towards the foot on one or more of their legs and begin licking…… and licking, and licking and licking.  The effect on the skin is no different than if you picked a spot on your arm and scratched at it round the clock.  The chronic self-inflicted irritation can result in thickening of the skin, increased pigmentation (skin appears darker than normal), an ulcerated surface with bleeding, and infection complete with pus, redness, and tenderness.  The average lick granuloma varies from dime-sized up to the size of a silver dollar.

Acral lick granulomas may be initiated by something that traumatizes or irritates the skin such as infection, allergy, or an embedded foreign body such as a thorn or splinter.  The dog overreacts lingually (no tongue in cheek here) and, over time, a lick granuloma appears.  It’s theorized that incessant licking may represent a self-soothing behavior (like thumb-sucking) associated with release of endorphins.  This theory is supported by the fact that, if one is savvy enough to interrupt the licking cycle at one site, many clever dogs redirect their attention to a new site on a different leg. Another possibility is that arthritis is present in the joint underlying the affected skin surface.  Licking is tantamount to a person massaging a sore joint.  Yet another theory is that boredom is the culprit. Truth be told, there are likely many different causes for lick granulomas.

The diagnosis of acral lick dermatitis is officially made via skin biopsy.  Your veterinarian may also recommend a skin scraping (material is scraped from the skin surface for evaluation under the microscope to rule out mange mites) and collection of samples for bacterial and fungal cultures.  Some veterinarians feel comfortable making the call based purely on history and visual inspection of the affected skin site.

Making the diagnosis is the easy part.  Stopping the licking is notoriously difficult.  In fact it can be a nightmare because many affected dogs simply will not be deterred from this obsessive behavior.  And even when one thinks the problem is licked (pun intended), a year or two down the road, the self-trauma cycle may begin all over again.

The ideal therapy for lick granulomas is identification and treatment of the underlying cause (foreign body, allergy, infection). If the cause cannot be determined (true for most dogs with lick granulomas) and eliminated, here are some therapeutic options.  Keep in mind, what works well for one dog may not work for another.

– Keep the site covered with a bandage.  You can use standard bandaging material or one of your own socks might be suitable.  Simply cut off the foot part and pull the tube section up over the affected area.  Secure in place with some tape.  If the lick granuloma is low enough on the leg, you can slip the dog’s foot into the toe of the sock.  A product called DogLeggs  may be worth a try as well.  If you are really, really, really lucky, your dog who is obsessed with applying his mouth parts to the spot you’ve covered will leave the bandage in place.  Warning!  It is extremely easy to put a bandage on that is too tight (a recipe for disaster).  Practice bandaging with a member of your veterinary team watching before trying it yourself at home.  Second warning!  Your dog may go one step beyond removing the bandage- he or she may eat the darned thing.  Close supervision is a must for the first day or two after accessorizing your dog with a bandage.  The last thing anyone wants is for a lick granuloma issue to morph into a gastrointestinal foreign body issue.

– Taste deterrents work for some dogs and there are a variety of products on the market (Bitter Apple is the classic).  If this is to stand a chance of breaking the cycle, application must be frequent and consistent.  Most dogs are so determined to lick that they will persevere in spite of the adverse taste reaction, and in all honesty, the looks on their faces after licking the nasty stuff time after time suggests that this “solution” may be less than humane.

– Elizabethan collars work well for some dogs.  Don’t forget to rearrange your house in advance so that nothing valuable is damaged as your dog learns to navigate his surroundings with a satellite dish around his neck.  (No, your television reception will not be enhanced.)

– Medications can be applied to the site that are antinflammatory in nature and/or help rebuild healthy tissue.  These typically must be accompanied by a method for keeping tongue away from skin so the medication has a fighting chance.

– Acupuncture and/or chiropractic treatments are thought to work for some dogs.

– Laser therapy at the site is successful with some lick granulomas.

– See if keeping your dog super-busy for a week or two breaks the cycle.  The hope is to alleviate boredom and/or create a dog that is too tired to lick.  Try increased play/exercise, a large Kong toy filled with peanut butter, doggie day care while you are away from home, or adoption of a playmate (careful here- sometimes the stress of a new animal in the household amplifies licking behavior).

– Behavior modification medications work for some incessant lickers, but should be tried when other efforts have failed.  Categories of medications that can be tried include tricyclic antidepressants, serotonin-inhibiting drugs, and endorphin blockers.

It’s a given that the more treatment options there are for a particular disease, the less we know about how best to treat it!  Lick granulomas are a classic example.  If your dog is afflicted, I strongly encourage you to enlist help from your veterinarian.  If, together you try two or three things without success, please consider consultation with a board certified dermatologist.  To find one in your neighborhood visit the American College of Veterinary Dermatology website.

Although a lick granuloma looks like a small problem, it can be downright difficult to cure.  If your dog’s lick granuloma remains small and clear of infection, and if the sound of licking is not keeping you awake at night, simply living with the problem is a reasonable choice to consider.

Has your dog had a lick granuloma?  If so, please tell us what you tried, what worked well, and what didn’t.

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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11 Responses to “Lick granulomas: An annoying little problem that is difficult to solve”

  1. Kelly says:

    My White GSD has bouts with licking until his legs are raw. I have discovered that it can get worse in the summer with the black flies. We live in the country. It appears that they drive him mental enough that he finds relief in licking. We use a great fly ointment and keep him inside when the flies are really bad (he loves to be outside to patrol the fence line). When he has a break from the fly bombardment the licking almost goes away completely.
    *Note he also had a licking bout when my son was born, but it didn’t last more than a few weeks.
    http://www.5dogsandababy.com/

  2. Lisa says:

    My dog had one. It started as allergies and then progressed to lick granuloma. My vet put him on a round of antibiotics and a lick deterrent to stop him. The deterrent didn’t work. We ended up bandaging the leg and that stopped the licking. However, he started in on the other leg. With mild redirection and occasional use of ecollar he left the other leg alone before causing a sore. His bandage comes off next week and we can check the progress off his sore. Hopefully another week of bandaged leg and he’ll be all better!

  3. lulu says:

    I had a golden lab who also licked at her leg and it wouldn’t heal. Later developed cancer and died.

  4. Mary says:

    I would like to share that my golden Amber developed this on the limb later dx with osteosarcoma

  5. Mitch Labuda says:

    We have a team member that would lick a paw, front or rear, the same way. Switched to grain free diet, and fish oil pills as a treat and the licking stopped. Of course, each is different, but humans can take steps to try and resolve, in addition to vet care.

  6. H. Houlahan says:

    For many dogs, and especially for long-term use, a well-ventilated basket muzzle (NOT a tight fabric muzzle) is preferable to an elizabethan collar. The Cone of Shame is terrible for the dog’s cervical spine and neck muscles, and can cause weird headshyness and tics with long-term use.

    And so many dogs with this problem are Dobermans, who tend to have terrible neck problems to start with.

    Sometimes what you need is this kind: http://www.vetmed.wsu.edu/cliented/images/dog_restraint/muzzle_plastic.jpg

    Because some canny dogs can lick through the otherwise preferable “cage” type of muzzle.

    Obviously eating needs to be under supervision, and the dog should get plenty of supervised active time without the muzzle.

    My second SAR partner gave herself a lick sore on the medial surface of one hock when she was deteriorating about 2 years after a hemilaminectomy. The paralysis returned slowly, I believe from scarring around the surgical site. She seemed to have parasthesia of that leg, and this is what I believe caused the licking.

  7. Eileen Salmas says:

    Thanks for the valuable information. My dog does some chronic licking – but thank heavens it’s not on his body. He’ll lick the carpet, his bedding or the pillow and blanket on my bed. Doesn’t make a difference if I wash the linens or clean the carpet – he’ll go at it for 10-15 minutes. So strange.

  8. Karen says:

    I’ve had two dogs in my life who had lick granulomas. In each case, they were later diagnosed with cancer.
    Is it possible a lick granuloma might be a symptom of unresolved pain somewhere else in the body, somewhere the dog cannot reach and so licks where it can easily reach, releasing the endorphins and helping with the pain?
    Has anyone else experienced anything similar?

  9. Shirlee says:

    Acupuncture worked wonders for me. I was amazed at how quickly it healed.

  10. Stephani says:

    This is a great post!

    I have two chronic lickers. Both have flea allergies and that starts the licking cycle. One also chronically licks other things (the floor and furniture, for instance) – this one is the easiest to redirect.

    In both cases, I am, fortunately, able to break the lick cycle by using interactive food-stuffed toys, more training and increasing the dogs’ daily exercise. But, it requires dedication on my part and lots and lots of food stuffed toys. The dog most prone to licking is happy to spend his entire day trying to get a bit of string cheese out of a Kong, rather than lick his leg raw.

    I often wonder if anxiety plays a roll in this cycle, too, since both dogs (both males) tend to be anxious, hyper alert and afraid of quite a number of things. So, while we do practice relaxation techniques and work on building confidence through training, I have to make sure that I increase the work we do on these things when the licking starts.

  11. Pat says:

    If you have a wood stove and use an Elizabethan collar, be careful with the dog and collar. It was summer, we wee fortunate, but I came home from work and the dog was stuck between the stove and the wall.