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Treatment of Lick Granuloma in Dogs

By: Dr. Nicholas Dodman

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Despite almost 10 years of scientific publication detailing the logical treatment of canine acral lick dermatitis (ALD), many veterinarians are still frustrated when it comes to dealing with this sometimes-refractory condition. Now, as in the past, many vets treat ALD as a local problem, attempting to use various salves and potions to reduce inflammation, control infection, and numb pain. While these treatments may offer some symptomatic relief, they are not therapeutic. The true motivation for true ALD is psychological, not physical.

Some conditions may masquerade as ALD. Apparent ALD lesions may result from trauma, local infection, tumors, allergy, or degenerative disease. To rule out physical disease-related ALD-like conditions, a number of tests may have to be run, including biopsy, deep culture, and X-ray. Once the diagnosis of true (psychological) ALD is confirmed, proper treatment can begin.

Physical Measures

While specific treatment measures take effect, it may be necessary to temporarily prevent the dog from inflicting further damage. Elizabethan collars or bandages designed to prevent the dog from licking or chewing her limb may be necessary for a while, particularly when the dog cannot be adequately supervised.

Definitive Measures

  • Addressing conflict. The first and most important step in treating ALD is to identify any conflict that the dog may be experiencing and eliminate it. Sometimes the conflict is separation anxiety. Sometimes it arises because of discord between animals in the home and sometimes it results from long hours of confinement and boredom. Sometimes the conflict is a thing of the past, though the compulsion continues. Other times the conflict is ongoing. Ongoing conflict must be addressed or the chances of permanent, successful treatment are nil.

  • Lifestyle optimization. All dogs, but especially ones with anxiety-based conditions, like ALD, should have their lifestyle organized to allow ample exercise opportunities, entertainment, a healthy diet, predictable feeding schedule and clear (one word) communication with their owners. Time inside crates or other enclosures, and confinement by means of chains, rope ties and runners, should be minimized or, even better, eliminated as a feature of the dog's daily life. Separation anxiety should be addressed. Conflicts between animals in the home should be resolved.

  • Medical tests. Sometimes borderline to low thyroid status can be associated with increased anxiety in dogs. Certain breeds, especially golden retrievers and German shepherds, are more likely to have this as an underlying medical complication. A thyroid screen is recommended if dogs of these breeds show subtle signs of hypothyroidism, such as excessive or prolonged shedding, allergies, or seizures. Optimizing thyroid status is sometimes partly therapeutic and improves the chances of success when using anti-obsessional drugs to treat the problem (see below).

  • Pharmacological treatment. The only drugs that work reliably to treat compulsive disorders in humans are the "anti-obsessessionals," including clomipramine (Clomicalm®), fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), fluvoxamine (Luvox®) and citalopram (Celexa®). The same is true for dogs. The drug of first choice in a dog is probably Clomicalm but not all dogs respond well to this treatment. For refractory cases, it may be necessary to switch to a so-called selective serotonin uptake inhibitor, such as fluoxetine.

    All serotonin uptake inhibiting anti-obsessional drugs take a while to work. Owners should not even look for improvement for at least 3 weeks. A noticeable effect may become apparent after about 1 month. Further gains may be made by the end of the second month of treatment, with perhaps 85 percent improvement after 3 months of treatment and 95 percent improvement after 4 months.

  • Adjuvant therapy. If the above serotonin drugs are not effective, their effect can be augmented by the addition of certain other compounds. One drug to try is the beta-blocker, propranolol (Inderal®). Propranolol increases the release of serotonin from nerve terminals thus augmenting the serotonergic effect of uptake blockade. Another augmentation strategy is to add an anxiety-reducing drug to the regimen. The Valium®-type drug clonazepam (Klonopin®) is sometimes used for this purpose in both human and veterinary medicine. Failing this, particularly in cases where separation anxiety is involved, supplementary medication with the hormone, melatonin, may help.

  • Other measures. It is almost always a good idea to treat dogs with ALD with a course of antibiotic for 1 to 3 months as, in many cases, there is secondary pyoderma (infection deep within the skin). If the infection is not treated, irritation and self-licking may persist. Allergies may also compound ALD.

    Conclusion

    When ALD is regarded as a central (brain/mind) problem, which it is, therapy becomes rational. Anxiety must be reduced in the dog's life by means of environmental and pharmacological strategies. Once the compulsion is under control, medication may sometimes be withdrawn without relapse. However, since ALD is genetically based, and feeds off an anxious and high-strung personality, successful treatment may only last until the next stressful event.

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