I have a dog with obsessive acral lick dermatitis. She had surgery to remove a granuloma, and the surgical sight completely healed with an E-collar. We removed the E-collar and now she is back to obsessive licking. It’s causing another sore. What can I do?

Cindy

Acral lick dermatitis is a physical manifestation of a psychogenic problem (psychogenic is how veterinarians say psychological). It occurs when dogs obsessively groom portions of their bodies. The most commonly affected sites are the wrist and ankle. The cause appears to be behavioral. The syndrome appears to be somewhat similar to obsessive-compulsive disorder and trichotrillomania in people. Predisposed dogs may overgroom in response to boredom, or excessive licking may be linked to stress or anxiety.

Dogs that lick enough will develop inflammation of the skin (dermatitis) in the overgroomed areas. The tingling and itching inspire further licking, which exacerbates the dermatitis, and an unfortunate feedback cycle develops. Worse still, in severe cases the licking is believed to release endorphins (natural brain chemicals that feel good). The result is that the cycle of licking can be extremely difficult to break.

Over time, the self-trauma inflicted by affected dogs progresses beyond dermatitis into a condition known as granuloma. Granulomas are areas of thickened, red, or pink hairless skin that take long periods to heal. Granulomas can be severe — I have met dogs whose entire legs consisted of skin that was nothing but granuloma. And they can form fast. I have seen dogs convert entire legs into granulomas in just a few days.

Acral lick dermatitis, like most behavioral or psychogenic issues, is very difficult to treat, and consequently very frustrating for the owners of affected dogs. The goal of treatment is to stop the licking.

To that end, Elizabethan collars (E-collars, or the dreaded cones of shame) are the most basic way to treat the problem. They (and similar tactics, such as application of bitter apple to the affected areas) are necessary in some cases, but I don’t like to use them as a first step. My preference instead is for enrichment.

Since acral lick is exacerbated by boredom, enrichment may help with the problem. The most basic form is exercise. Dogs that are worn out from long walks or nice fetch sessions may be too tired and content to overgroom. Finding ways to slow down and delay feeding may help with the problem as well. The use of foraging balls and Kongs filled with canned food and then frozen are examples of such tactics.

Mental enrichment is also recommended, which might be accomplished through training or agility practice. Consulting with a trainer or behaviorist to work out sources of anxiety also might yield good results.

Finally, medications may help. Those most frequently used are the same ones used to treat obsessive-compulsive disorder in humans. Fluoxetine (known as Reconcile when dogs take it and Prozac when people take it) and clomipramine (Clomicalm) are antidepressants, which may reduce the urge to overgroom. As always, I do not recommend using antidepressants as a first step, and I never recommend medications without a comprehensive enrichment and behavioral modification program. However, if my dog were faced with the choice of taking Prozac or wearing an E-collar continuously, I know which one he (and I) would prefer.

Remember that true acral lick dermatitis is primarily behavioral in nature, although sometimes medical issues can trigger or exacerbate the problem. Allergies to fleas, food, and environmental agents should be explored and ruled out or treated as appropriate in any dog with the syndrome.

Sick dog photo courtesy of Shutterstock.com