Lick Granuloma - Treatment

Treatment

Treatment of the primary cause, if known, is essential. The dog should be tested for allergies, and treated accordingly if positive (fatty acids, antihistamines, hypoallergic diet, etc.). It may also be necessary to check thyroid levels as hypothyroidism seems to play a role in some cases, particularly in black Labrador retrievers; thyroid medication often will resolve the problem if it's due to hypothyroidism.

Recently, a new dermatology bioscaffold developed by TR Matrix evidenced a reduction in lesion size, inflammation, and improvement in hair growth in dogs with refractory distal limb lesions (pending abstract).

In psychogenic cases, dealing with psychological factors is most important. Factors should be identified such as being left alone all day, being confined, and changes in the household. Correction of these causes may include increased walks, avoiding confinement, and more interaction in the home.Some veterinarians have recently proposed that diet can affect compulsive behaviors in dogs.

Drugs may be used until behavior modification has had time to take effect. Antidepressants are most commonly used, including doxepin, amitriptyline, fluoxetine, and clomipramine. If the psychological factors are not corrected, the dog will usually relapse after the drugs are discontinued. Endorphin blockers such as naltrexone can be used to reduce addiction to licking, or endorphin substitutes such as hydrocodone may decrease the urge to lick.

The lesion should also be treated. Licking can be prevented by the use of Elizabethan collars, battery enhanced wraps, bandages, anti-licking ointments (which are bad tasting) and anti-lick strips (which are either bad tasting or simply provide a barrier). It is important to catch lesions early and keep the dog from licking them to then reduce inflammation and development of a habit. Topical medications such as corticosteroids or DMSO may be effective if used early.

Small lesions may be injected with triamcinolone or methylprednisolone. Oral antibiotics are used to control infection. Surgery may be performed to remove whole lesions, but there is risk of continued self mutilation to the area afterwards. Other potential treatments include cryosurgery, laser surgery, radiation therapy, and acupuncture. It is important to note that many dogs will lick at another leg, another area on the same leg, or someplace else, creating a new lick granuloma, if they are prevented from licking at the original one while it heals.

Overall, lick granulomas are very difficult to treat, with control only being achieved in about 65 percent of cases. Some dogs will continue to lick at the area despite the use of anti-lick ointments or sprays to deter them for instance.

Frequent formations of lick granulomas in the same area due to the constant licking will cause hardening, caluse formation, hair loss (the hair may stop growing back), and hyperpigmentation to that area.