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Canine lick granulomaWhen a pet owner brings their animal in to the vet with a firm, raised, angry red bump on the pet’s leg or ankle, complaining that the animal (a dog more often than a cat) won’t stop licking at it, the vet knows that there is a potentially long road of diagnosis and treatment ahead. The symptoms and behaviour described here are common in what’s called acral lick granuloma

What is an acral lick granuloma?

An acral lick granuloma is a medical condition whose main feature is a raised, angry red bump on the pet’s leg. This angry bump is usually the centre of the pet’s focus, where they constantly lick the area until it is raw.

If we unpack the name of the condition, it gives us a better idea of what it is and how it is caused. Acral refers to peripheral body parts, so the extremities like legs, ankles and paws. This condition usually affects the furthest end parts of the legs; more commonly the front legs, but also the back. The lick part of the name defines the cause of the condition, namely long-term licking, which aggravates the skin and leads to irritation and ulcers. A granuloma is the body’s response to long-term irritation; in this case irritation to the skin. A granuloma comprises clumps of irritated tissue, which usually appear raised like a mushroom on the surface of the skin.

So an acral lick granuloma is a condition where the body creates a granuloma on the leg/s as a result of long-term licking.

What does an acral lick granuloma look like?

Not all acral lick granulomas look identical, but they all share some basic characteristics. They usually appear as thick, firm, raised, hairless areas on the top of the front or back legs. These areas sometimes have a ring of darker coloured skin on the edges. Pets who have this problem compulsively lick the area, even if you scold them or try to distract them. It’s as if they can’t help themselves. Acral lick granulomas develop as a result of long-term licking and develop slowly over time. Long-standing cases have ulcers that develop on the topmost surface of the granuloma. These areas often have an underlying infection, so they can appear red and angry, sometimes oozing a pussy, red or straw-coloured liquid. 

Which animals can get acral lick granulomas? 

Both dogs and cats can develop an acral lick granuloma, but it’s more prevalent in older animals than in younger animals. Retrievers and high focus breeds like Dobermans, Irish setters and German shepherds tend to get this problem more commonly than others.

What causes an acral lick granuloma?

There are several theories about what leads to the development of an acral lick granuloma. Many researchers believe that this condition is mainly caused by psychological factors; that it is stress-related. There is yet other evidence that suggests that there may be an underlying medical problem that starts the licking cycle. These conditions include pain, irritation, infection and discomfort. Conditions such as arthritis, pain related to bone conditions, infections, injuries and even itchy skin-related conditions such as allergies or parasites may kick off the animal’s need to lick.

When a pet licks the area of pain or discomfort, it releases feel-good hormones, making them want to keep licking. This soothing effect is most likely how the lick cycle is maintained once it has started, which results in compulsive licking.

In cases where an initial physical cause of the problem could not be found, studies found that many of the dogs with acral lick granuloma had a psychological origin. Many of these dogs started licking as a response to stress, anxiety or boredom. Many of them started licking after a change in their environment. Examples include dogs who were crated for longer than usual, a change in their owner’s working hours, or even the loss of a friend or family member.

I think my pet may have an acral lick granuloma, what can I do?

If you suspect that your pet has an acral lick granuloma, the best would be to discuss the condition with a veterinarian. It is important to find out what started the problem in the first place. The veterinarian will examine your pet and possibly recommend x-rays or even collect samples from the area to rule out bone or joint problems, parasite infections or even cancer. The cause of the problem needs to be addressed if there is to be any hope of a solution. Each case is unique and treatment administered will depend on the cause.

Possible treatment routes

More often than not there is infection hiding deep in an acral lick granuloma, which requires long-term antibiotic treatment. This may be for weeks or months, and requires diligent effort to maintain on the owner’s part. Resolving infection in these cases is the cornerstone to successful treatment. An important component of managing an acral lick granuloma is to limit your pet’s access to this area once treatment has started. This can be done by bandaging the area or by using a cone, or Elizabethan collar.

In cases where psychological stress is a major contributor to the condition, the veterinarian may recommend a consultation with a behavioural specialist who can assist in managing the stress-related aspect of this condition. 

Keeping an eye on when your pet licks may indicate the psychological contributor to the condition. Do they lick more when they are on their own or when surrounded by people? Do they lick when locked up in their crates during the day or night or when they are alone or bored? Do they show other symptoms related to separation anxiety, like not being able to leave your side when you are at home? 

An acral lick granuloma can be a frustrating condition to treat and manage. The granuloma develops slowly over time, so you may not know there is a problem until it is well established. An important part of treating these lick granulomas is finding and treating the initial cause. Without finding the initial cause, they tend to recur. Always speak to the vet about your concerns regarding your pets.

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