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.

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.

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.

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.

Marvista Veterinary Hospital

What is Acral lick dermatitis?
Acral lick dermatitis is a condition similar to bed sores in people that occurs most commonly on pressure points and on the lower joints of the legs of dogs and occasionally cats. Unlike bedsores, however, the cause of acral lesions is constant licking. Unless a dog is exceptionally high strung and obsessive, this problem usually does not occur until the pets are five or six years old. In my experience, it affects both sexes equally. Phlegmatic, couch potato pets seem more disposed to this disease and I see it most commonly in Doberman Pinchers and Golden Retrievers.

This is a fairly common problem in older, sedentary dogs. Many of them are overweight as well. As pets age and arthritis and obesity make them less mobile, they spend more and more time grooming themselves – an activity that requires less energy. Sometimes the lesion begins as a scrape or pustule; but often there is no apparent defect at the site where licking begins. It is very uncommon for a dog to have more than one or two of these areas on his or her body. As they continuously lick these areas, hair is lost, the area becomes firm and raised and superficial staphylococcal infections often set in. With time the skin of the area thickens and either gains or looses pigment. The resulting wound is called a granuloma. The center of these lesions is often ulcerated. These wounds are often unsightly but never life-threatening. Scabs rarely form because of incessant licking. 

We do not know with certainty what causes acral lick granulomas. Some possible causes of the licking behavior include, trauma, itching, peripheral nerve irritation, boredom, allergies, skin infection, arthritis or other joint problems. Boredom, confinement, loneliness and separation anxiety have also been implicated. It is often very difficult to determine if a physical or psychological problem is causing the dog’s obsessive licking and grooming of the area.

We diagnose acral lick granuloma through a careful examination of the lesion, the pet’s history, age and a thorough physical exam. Occasionally I will send a skin biopsy to a pathologist to rule out cancer. I may x-ray the area to be sure no bone spurs, arthritis or periostitis (inflammation of the covering of the bone) are the cause. I may try the pet on a hypoallergenic diet for sixty days to rule out allergies. Occasionally I will run a bacterial culture of the area. Acral lick granuloma is the diagnosis when all these tests come back negative. 

The most effective way to eliminate this problem is to bandage the area with a light dressing. Bitters sprays and ointments almost never work. I am most successful when we begin treating these lesions early. After years of licking few treatments are successful. Some times I will place small ringlets of stainless steel wire (body pierces) in the area with sharp ends that discourage licking. Other times I tranquilize these dogs with acepromazine to discourage licking. Elizabethan (restrictive) collars sometimes cure the condition but it often reoccurs when the collars are removed. Encouraging exercise through weight reduction or a second, younger pet sometimes cures the problem. If I think the problem is psychological (obsessive/compulsive behavior), I often place these dogs on chlomipramine hydrochloride, an anti-obsessional drug that belongs to the dibenzazepine class of tricyclic antidepressants. Frequent, small feedings also help to relieve boredom. Occasionally, Phenobarbital also is helpful. If I think arthritis may be the underlying problem, I put the dogs on anti-arthritic drugs such as Etogesic (etodolac) or Rimadyl.( carprofen) If a significant bacterial secondary infection exists, I place the dog on a good antibiotic. Sometimes I combine these antibiotics with a long acting anti-inflammatory agent such as methylprednisolone acetate. Sometimes, ear preparations such as Tresaderm or Panalog massaged into the areas help. If these lesions are surgically removed, they often reoccur in the same area. No matter what the cause, I often put them in a restrictive collar muzzle or bandage to give the lesion a chance to heal. 
There is one theory that licking these lesions releases “feel good” endorphins (brain chemicals), which cause the cycle to continue. I do not know of any medication that would break such a cycle. Perhaps providing a lot more “feel good” activities is the answer since boredom seems to be one of the major causes of this disease.

Outlook or Prognosis:
The good news is that this condition is generally no more than an unsightly blemish. The bad news is that veterinarians rarely cure it once it becomes a well-established habit. Again, the earlier it is recognized and treated the more hope there is for a permanent cure.

Transmission: There is no evidence that this is a transmissible disease. In any case, it is always wise to wash your hands after touching these lesions. There is also always the possibility of producing “super resistant” bacteria that can spread to other family members if this problem is treated overzealously with antibiotics.

Ron Hines DVM PhD

Skin Problems and Excessive Licking - Multi Faceted Treatment:

Excessive licking and scratching so that bare spots appear, is not natural. The underlying reasons are often complex and you must attack the problem using several methods. Sometimes the dog is just bored and needs more physical exercise. If not treated, the behaviour can become compulsive which requires a different kind of additional treatment.

Skin rashes can be caused by many things and are usually complex. They can be food allergies, or they can be a sign of vitamin and mineral deficiencies or they can be a sign of microscopic mites, or all of the above. When a deficiency of vitamin and minerals takes place, the malnourished animal, has a depressed immune system, and is often subject to an attack of microscopic mites which get under the skin and irritate it. The dog's scratching makes it worse, and causes infection.

Steroids will help alleviate the symptoms, but rarely do anything for the underlying cause. As soon as the effect of the steroids wears off, the symptoms return. Too many steroids can cause the immune system to be suppressed, which is just the opposite to what you must accomplish -not good.

Suggestions for attacking the problem.

  1. Take your dog to the Vet for a check up.

  2. Buy a 20cc bottle of "Bach's Rescue Remedy" (about $10.00 at your nearest health food store). This is a product which has stood the test of time, since the 1920s. Many Vets say it should be in everyone's first aid kit - for humans and for animals. It is an excellent product, no doubt about it! It seems to reduce anxiety and stress which then gives a boost to the immune system - very important! It comes with a 4 drop eyedropper - perfect size. Just put 4 drops right on the tongue or gums of the mouth. Do it about 3 times a day. It is excellent for any kinds of maladies, stress and trauma. It is safe and you won't overdose on it. The results on animals can be rapid and dramatic depending on the problem. It's an excellent second step.

  3. Examine the contents of the food being fed to the dog. Check for corn. Many dogs cannot tolerate corn. Sometimes as dogs get older, what didn't bother them before, suddenly causes problems. The Vets usually suggest switching to lamb and rice products. Switch! Sometimes various yeast additives can be the culprits.

  4. Start giving vitamin and mineral supplements to the dog. Your Vet can suggest some. In addition, one or two crushed chewable vitamin C (500 - 1000gm) can be added to the dog's meal once a day. Dogs synthesize their own vitamin C but it is usually bare minimum and in our polluted environment, especially for older dogs, it's often not enough. Vitamin E (from natural source) should also be fed about 3 times a week (about 200 - 400 IU depending on the size of the dog). Whereas, vitamin C will not usually cause any harm if more is given, you should not overdose the dog on vitamin E. Consult your vet for a safe dosage of vitamin E. Vitamin E will help the skin to heal, and just like C, it also gives a boost to the immune system - very important.



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