Lick Granulomas


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Acral Lick Granulomas

Acral lick granulomas are a common problem in dogs. There are a number of treatments that have been advocated for this problem, mostly because none of them is consistently successful in eliminating all cases of lick granuloma.

Lick granulomas can occur secondary to allergies -- in this case, treatment for the allergy is often successful. It is a good idea to consider allergy testing in dogs with persistent lick granulomas or recurrent ones. The standard treatments for allergies are itch control medications or hyposensitizing "allergy shots". Skin testing is the most accurate way to diagnose allergies. Veterinary dermatologists frequently do this. Blood testing for allergies is considered to be less accurate but can be substituted when skin testing is hard to arrange.

Acral lick granulomas can occur secondary to injuries, underlying bone infection (this is a tricky diagnosis because the persistent licking can lead to periosteal inflammation around the bone making it seem like an infection was the cause), bacterial skin infection, parasites and other physical causes.

These lesions are thought to be due to stress or boredom in some dogs and even to be an obsessive/compulsive disorder in others.

So the first step in treatment is to do a thorough examination for an underlying cause. If one can be identified, it should be treated. If a bacterial infection is suspected antibiotics must be used for at least 6 to 8 weeks. If an underlying cause can not be found then the lick granuloma itself should be treated. There are a number of ways of doing this. Topical treatment with a combination of Synotic and Banamine has been advocated. Local anesthestic preparations like DermaCool or Relief can be helpful. Application of aversives like bitter apple or chloramphenicol ophthalmic ointment is sometimes done. Bandaging or using a sock to cover the lesion helps in some cases. A good adjunct to this type of therapy appears to be administration of hydrocodone to cut down on the irritation and/or fill the need for endorphins that the dog may be experiencing.

The psychological cases can respond to simple changes in environment (reducing stress or boredom). In more difficult cases, amitriptyline (Elavil), naltrexone (Trexane), clomipramine (Anafranil) and fluoxetine (Prozac) have been advocated. Acupuncture is reported to work well in some dogs, anecdotally.

For really desperate situations, radiation therapy, casts over the area, cryosurgery, and surgical excision have all been attempted.

This condition is frustrating and often will take several approaches to find the one that will work. Keep working with your vet to find a solution to the problem for your dog.


The so-called "Lick granuloma" is a raised, usually ulcerated area on a dog's wrist or ankle area caused by the dog's own incessant licking.


This type of foot-chewing may be compared to nail-biting in people.  We chew our nails when we are bored or worried, out of habit, or even as an obsessive/compulsive behavior.  Often, we find similar motivations in these foot-chewing dogs.  Frequently, there has been a change at home such as:

  • lengthy confinement
  • addition of a new pet or human house-guest to the family
  • death or loss of a companion pet
  • loss of owner or absence of a family member
  • moving to a new home
  • boredom

For many dogs, treating the skin lesion is not enough; the dog must be palliated psychologically as well. Extra attention to the pet on a reliable basis may be all that is needed; however, some dogs actually require psychoactive drugs.


There is a lot of disagreement as to the best treatment to attempt first in a case of lick granuloma. Here is a summary of what we have found effective for most cases:

  • A long-acting corticosteroid injection helps reduce the itchy sensation associated with healing.
  • Special wraps covering the wound allow healing to take place (though, at first, often an Elizabethan collar is important to keep the pet from bothering the wrap.)
  • Some veterinarians prefer specially mixed topicals to reduce inflammation in these areas.
  • Many lick granulomas may require a minimum of three weeks on antibiotics to clear the skin infection.


For dogs who resume chewing as soon as treatment is discontinued or who simply change to a new foot, more than just extra attention may be necessary. The following medications are commonly used for people in reducing stress or depression as well as for treating obsessive/compulsive disorders.

AMITRIPTYLINE - helpful in only 30% of dogs but considerably cheaper than the others.  It takes 4 weeks on medication to determine if there will be an effect. If the medication is found helpful, the pet continues on it.

Approx. cost for 1 month of treatment for a 75 lb dog = $15.00

PROZAC - helpful for 50% of dogs that lick.  The medication is given for 4 weeks.  If no response is seen, the dose is doubled for another 4 weeks. Medication is discontinued if a good response is seen.

Approx. cost for 1 month of treatment for a 75 lb dog = $135.00

NALTREXONE - helpful in 50-60% of cases. The pet takes the medication for only one month. If licking stops, it usually is stopped for weeks to months. Should licking resume, another course of medication may be instituted.

Approx. cost for 1 month of treatment for a 50 lb dog = $210.00

ACUPUNCTURE - has recently gained favor as a possible treatment and may be worth looking into.

Some consultation with a behavioral specialist may be in order for more resistant cases.