Lick granuloma, also known as acral lick dermatitis, is a common skin lesion that develops because of a dog’s personality.

Typically, the lesion starts as an area of hair loss and red inflamed skin. Eventually, it becomes raised above the skin and becomes firm similar to a callus.

Although these lesions can occur on any leg, they are commonly on the front legs. They develop on top of the wrist or carpal joint which is the easiest place for a dog to lick when lying down.

Initially, the lesion looks similar to a hot spot.

The difference is hot spots respond well to treatment and lick granulomas persist despite treatment.

Lick granulomas develop and grow due to excessive licking by the pet, especially when the pet is alone or when the family is sleeping.

Literature suggests certain breeds are more prone to lick granulomas such as dobermans, great danes and retrievers.

I have seen them in all different breeds, even mixed breeds, and don’t see any one breed having more of a problem.

The actual cause of lick granulomas is not completely understood. Generally, it is accepted they are probably multi-factorial or have many factors that play a role in their development.

Most researchers agree psychological factors such as stress or boredom are the initial factors.

Other factors tend to add to and exacerbate the condition as secondary contributors.

The chronic nature of the condition is usually associated with a deep bacterial infection.

Research has shown microscopically lick granulomas contain hundreds or thousands of tiny micro-abscesses.

This helps explain the difficulty in treating them. Micro-abscesses are like walled-off pockets of pus that are very hard to penetrate with antibiotics.

Lick granulomas are certainly one of the most frustrating conditions veterinarians regularly  face. They are a viscous cycle.

If a dog licks an area on their leg, it becomes irritated. The more irritated it becomes, the more they lick at it. The more they lick at it; I think you understand.

Fortunately, lick granulomas are not life threatening and they rarely cause any significant pain. They simply seem to either itch intensely or just appear that way because of the dog’s neurotic behavior of excessive licking.

Most of the time, these lesions can be diagnosed simply by your veterinarian examining your dog’s leg. If the lesion does not look typical of a lick granuloma, diagnosis conformation may be obtained with a biopsy of the lesion.

Additionally, the wrist joint can be X-rayed to rule out arthritis in an older dog that may be licking the joint due to pain.

Lick granulomas are frustrating to manage and treat. If the owner is diligent and willing to pursue extended treatments, most cases can be resolved.

Often an underlying cause must also be addressed to prevent reoccurrence or new lesions.

Long-term antibiotics are usually necessary to treat the micro-abscesses which contain infection.

Oral anti-inflammatory medications can be used to stop the intense itching and reduce the swelling caused by the inflammation.

Topical medications have been used extensively with a variety of results.

Most of the time, topical medications are licked off by the dog before having any chance of working.

One train of thought is not to use anything topically because you simply bring the dog’s attention to the lesion making them lick it even more than ever.

Regardless of the protocol for treatment, most dogs benefit from wearing an E-collar which is a plastic cone around their head preventing them from reaching the lesion on the leg.

Most importantly, the underlying cause must be addressed in order to facilitate the healing process and prevent reoccurrence.

Since the root cause is often related to anxiety or boredom, countless techniques may be instigated to increase interaction and stimulation.

Sometimes medications used to treat anxiety or boredom, psychological drugs, may be used to treat and manage patients especially if they have been shown to respond well to this type of treatment.

After years of frustration and treatments that have failed, laser surgery has revolutionized treatment of the all too common lick granulomas.

Many veterinarians can use their CO2 laser to remove the lesions. The laser works to burn the lesion off and cauterizes the nerves as it cuts.

This allows the area to be much less painful than cutting with a traditional scalpel blade.

After surgery the dog is much less likely to continue licking the incision area.

If your dog starts to lick excessively on one of his legs, contact your veterinarian as soon as possible to ensure your dog lives a long, healthy and happy life.

Dr. Jeff Castle is a veterinarian at Clark County Veterinary Clinic.