Lick Granuloma

Your dog is constantly licking one area of skin. It becomes inflamed. The sore spot can’t heal because your dog is constantly licking it. That leads to itching. And more licking. It’s a vicious cycle of itching and licking. This is a lick granuloma.

Lick granuloma is an injury to your dog’s skin caused by chronic licking. The condition is also called acral lick dermatitis (the word “acral” simply pinpoints the location of the problem to a limb or other extremity).

The most common location for a lick granuloma is on the front limbs between the elbow and toes. Chronic lick granulomas are typically raised areas of ulceration that show hair loss and thickened skin around the lesion. Middle-aged, large breed dogs are most often affected.

Secondary conditions that can result from lick granuloma are bacterial infections, yeast infections, furunculosis (ruptured hair follicles) and ruptured apocrine glands (a type of sweat gland). Any of these secondary problems can make your dog’s itching worse and prolong the itch-lick cycle.

What Causes Excessive Licking?

Many veterinarians believe itchy skin triggers the excessive licking that creates acral lick dermatitis. It’s also possible that a painful condition is the genesis of the itching. It might be trauma to the leg, a fracture, post-surgical discomfort, osteoarthritis or peripheral neuropathy. Additionally, chiropractic problems such as nerve impingement or referred spinal pain may also contribute to excessive licking. A bacterial or fungal infection can also set things in motion, as can an infestation of skin mites.

Lick GranulomaSometimes incessant licking has a psychological cause such as canine obsessive-compulsive disorder (OCD). Persistent licking may trigger the release of endorphins, and so the dog learns to repeat the behavior to induce a pleasant sensation.

Other psychological factors involved in obsessive licking include boredom, stress and separation anxiety. It’s important to determine the cause of your dog’s licking so it can be successfully treated.

Is it allergies? Take a look at our ultimate allergy guide. [Find it here]

Diagnosing Lick Granuloma

The first step in diagnosing lick granuloma is to rule out any potential underlying allergic diseases. For example, if your dog has recurrent skin or ear infections, hot spots, or itching in other areas of the body, he quite likely has a generalized allergic condition that must be addressed. A possible allergy to fleas, food, or something in the dog’s environment should be investigated. Completing sensitivity testing such as Dr Dodds’ Nutriscan can highlight food sensitivities that can be exacerbating your dog’s inflammatory response.

Several tests are necessary to confirm a diagnosis of lick granuloma. These include deep skin scrapings (to check for mites) and skin cultures to check for infection. And rarely, skin biopsies may be necessary to rule out other pathological issues, such as cancer.

Most lick granulomas involve a bacterial infection.

Generally speaking, if your dog has no behavioral abnormalities beyond the constant licking, and while the licking may escalate to an obsessive level over time, chances are the condition isn’t rooted in OCD or another psychological disorder.

Treating the Wound

I use a variety of topical remedies to speed the healing of lick granulomas because no one remedy works for every dog. A few options to try include:

  • Manuka honey applied to the wound three to four times a day. You’ll want to have an E-collar or Bite Not collar in place before you apply medical honey to your dog’s leg.
  • Willard’s Water sprayed on the wound six to eight times daily
  • Bee propolis salve (Pavia Natural Wound Care Cream) applied twice daily
  • Fresh aloe gel applied three to four times daily
  • Calendula or hypericum tincture or gel applied three to four times daily
  • Chamomile tea bag poultice: steep one herbal teabag in a half cup of hot water, let cool. Add 20 drops colloidal silver. Refrigerate until the infusion chills. You can apply the cold teabag directly on the wound, securing it with a light wrap. If you dog won’t tolerate this then dab the solution directly on the wound six to eight times daily
  • Essential oils: mix five drops of lavender oil and five drops of myrrh oil with one teaspoon of coconut oil. Mix well. Apply to the wound two to three times a day.

If using essential oils, just make sure to dilute them. [Check out this post for more on why]

To successfully heal the wound, you must prevent your dog from licking it, and the area must be cleaned twice a day.

Cold laser therapy and the Assisi loop (a pulsed electromagnetic device) may be helpful in some cases, and acupuncture can be an excellent adjunctive therapy for chronic cases. Addressing any chiropractic subluxations is also important. Sometimes healing touch, such as Reiki, can also reduce your dog’s desire to lick the area.

To prevent your dog from bothering the wound while it heals, an Elizabethan (E-collar) or Bite Not collar is sometimes necessary if you’re not always there to supervise. A collar will not only remove the dog’s ability to lick the sore spot, it will also help break the obsessive itch-lick cycle.

Another option is to apply a light, nonstick bandage over the wound, taking care not to make it too tight. However, many dogs will simply lick or chew the bandage off (and even eat it), so this isn’t a workable solution for everyone.

Tackling Psychological Causes

If you suspect your dog’s licking is caused by psychological or emotional factors, you’ll need to address those to prevent the problem from recurring. Often a good place to start is by increasing the amount of exercise your dog gets. Large breed dogs need lots of physical activity, and any dog can develop behavior problems if he spends a lot of time alone or doesn’t get opportunities to exercise.

Changes in your dog’s environment can be stressful and trigger behavioral issues. For example, perhaps another pet in the household has died or a new pet has been added. Try to insure everyone in the family pays extra attention to your dog during periods of change or stress. Activities such as a K9 Nose Work class can be incredibly beneficial for stressed dogs.

It’s also important to try to resolve any conflict in your dog’s life such as separation anxiety, problems between animals in the home or long periods of confinement or boredom.

Lick GranulomaTo be well balanced, your dog needs playtime, activities that stimulate his brain, a balanced species-appropriate diet, a consistent daily routine and regular interaction with you.

Crating or otherwise confining a dog for several hours a day leads to loneliness and boredom, which can aggravate anxiety-based behaviors like chronic licking. If you’re gone from home for long periods during the day, consider doggy day care or a dog walking service to give your pet opportunities for companionship and exercise in your absence.

It’s not uncommon for conventional veterinarians to prescribe anti-depressants or anti-anxiety drugs, either short or long term, for dogs with lick granulomas. These drugs are powerful and have undesirable side effects. I recommend trying natural anti-anxiety nutraceuticals first. These include: L-theanine, GABA, 5-HTP, melatonin, valerian and Chinese herbs to calm the shen. There are also several homeopathic remedies that can be very beneficial, depending on your dog’s specific symptoms. Work with your holistic vet to find the right protocol.

Is your dog nervous or easily stressed out? [Read this post for some great remedies]

Prevention Tips

  1. The best way to prevent your dog from developing acral lick dermatitis is to deal with obsessive licking behavior at the first sign of it. Some lick granulomas can develop very quickly – within a matter of hours. Others take longer to appear.
  2. If you can avoid it, don’t wait until there’s an obvious injury to your dog’s skin before seeking advice from your veterinarian.
  3. Develop the habit of running your hands over your dog – especially down the front legs – to check for damp fur or sensitivity.
  4. If your dog tends to place himself outside your line of vision, check on him frequently to ensure he isn’t hiding his obsessive licking from you. Stained fur is a sign he’s licking.
  5. If he’s licking a certain spot but there’s no injury yet to the skin, try lightly wrapping the area in an Ace bandage to discourage further licking. Sprinkling the area with an all-natural lick deterrent such as lavender essential oil can also reduce the urge to lick.
  6. You’ll still need to see your holistic veterinarian to identify and deal with the underlying reasons for the licking, but in the meantime, anything you can do to prevent your dog from self-injury will be beneficial.