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My dog has a bump on his paw - I have a picture. We went to…

Customer Question
Hi there, my dog...

Hi there, my dog has a bump on his paw - I have a picture. We went to the vet and they said to keep an eye on it and then if it gets worse to come back. The size is th same except he licks it a lot and now it’s getting more red and having a little bit of fluid coming out. I washed it and put a bandaid on it. He is eating and acting normal.

Veterinarian's Assistant: I'll do all I can to help. What is wrong with your dog?

Thank you Pearl.

Veterinarian's Assistant: Where does your dog seem to hurt?

Right front paw

Veterinarian's Assistant: OK. What is the dog's name and age?

Size of quarter

Veterinarian's Assistant: What is the dog's name?

Licko, 5 years Boston’s terrier

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Licko?

No just that he’s a great dog:)

Submitted: 2 months ago.Category: Dog Veterinary
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Customer reply replied 2 months ago
5 year old Boston Terrier. He is eating and acting normal.
Today he was licking the spot obsessively and a bit hyper, so I cleaned the area and put a bandaid on the spot and a cone for a few hours. This calmed him down and got him to stop licking it.
Answered in 8 hours by:
12/17/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 32,202
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 months ago

Thank you for the photos. I'm sorry that your question wasn't answered in a timely manner. This appears to be a benign histiocytoma - neoplasm of mononuclear cells derived from epidermal Langerhans' cells. I apologize for the pedantry. It's common in dogs with highest incidence in young adults younger than 4 years of age. It usually manifests as a solitary, rapidly growing, firm, well-circumscribed, erythematous (reddened), raised, alopecic dermal nodule that ranges from 0.5 to 4 cm in diameter. Lesions may be ulcerated and occur most commonly on the head, ear pinnae, and legs. Observation without treatment is reasonable because most lesions regress spontaneously within 3 months. Surgical excision or cryotherapy is curative for lesions that don't regress spontaneously.

Images of histiocytomas: https://www.google.com/search?q=google+images+histiocytoma+dog&rlz=1C1CHBF_enUS720US720&tbm=isch&tbo=u&source=univ&sa=X&ved=0ahUKEwibzpHHy__WAhWps1QKHSyVAhAQ7AkIMw&biw=1920&bih=949

An important differential is a ringworm (fungal) kerion. Licko's vet can needle aspirate this and examine the aspirate microscopically in an attempt to clarify if this is, indeed, a histiocytoma or, instead, the more dangerous mast cell tumor. Fungal culturing hairs around the periphery of this is needed to confirm ringworm. Please respond with further questions or concerns if you wish.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 months ago
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
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Customer reply replied 2 months ago
Hi Dr Michael, thank you for your response.
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 months ago

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 months ago

It appears to be spreading and so a histiocytoma is unlikely. Ringworm fungus and mast cell tumor still need to be differentials but I also need to consider an acral lick dermatitis consdiering his excessive licking at this area. Licko needs the attention of his vet. Here's what you need to know about acral lick dermatitis:

Acral lick dermatitis is first noted as excessive, compulsive licking at a focal area on a limb, resulting in a firm, proliferative, ulcerative, alopecic lesion. Causes of the licking are multifactorial and although environmental stress (e.g., boredom, confinement, loneliness, separation anxiety) may be a contributor, other factors are usually more important - hypersensitivity (atopy - allergies to environmental allergens such as pollens, molds, dust, dust mites, etc.; food), fleas, trauma (cut, bruise), foreign body reaction, infection (bacterial, fungal), demodicosis (Demodex mange mite), hypothyroidism, neuropathy, osteopathy, arthritis). The dermatitis is common in dogs with the highest incidence in middle-aged to older, large-breed dogs, especially Doberman pinschers, Great Danes, Golden retrievers, Labrador retrievers, German shepherds, and Boxers.

The lesion usually begins as a small area of dermatitis that slowly enlarges because of persistent licking. The affected area becomes alopecic, firm, raised, thickened, and plaque-like to nodular and it may be eroded or ulcerated. With chronicity, extensive fibrosis (scarring), hyperpigmentation, and secondary bacterial infection are common. Lesions are usually single but may be multiple and they most often are found on the dorsal aspect of the carpus ("wrist"), metacarpus, tarsus, or metatarsus.

The underlying causes should be identified and corrected (see above) with the help of his vet. One should treat for secondary bacterial infection with long-term systemic antibiotics (minimum 6-8 weeks and as long as 4-6 months in some dogs. Antibiotic therapy should be continued at least 3-4 weeks beyond regression of the lesion. The antibiotic should be selected according to bacterial culture and sensitivity results. Anecdotal reports suggest good efficacy with combined antibiotic, amitriptyline (2 mg/kg every 12 hours), and hydrocodone (0.25 mg/kg every 8-12 hours administered until lesions resolve. Then one drug should be discontinued every 2 weeks until it can be determined which drug (if any) may be required for maintenance therapy. Topical application of analgesic, steroidal, or bad tasting medications every 8-12 hours may help stop the licking but response is unpredictable and often disappointing. When no underlying cause can be found, treatment with behavior-modifying drugs may be beneficial in some dogs - anxiolytics, tricyclic antidepressants, endorphin blocker, and endorphin substitutes are all available through his vet. Trial treatment periods of up to 5 weeks should be used until the most effective drug is identified. Lifelong treatment is often necessary.

Alternative medical treatments such as cold laser therapy or acupuncture have been beneficial in some patients. Mechanical barriers such as wire muzzles and side braces may be helpful. Surgical excision or laser ablation isn't recommended because postoperative complications, especially wound dehiscence, are common. Laser ablation may help sterilize the lesion and deaden nerve endings; however, response is highly variable. The prognosis is variable. Chronic lesions that are unresponsive or extensively fibrotic and those for which no underlying cause can be found have a poor prognosis for resolution. Although the disease is rarely life-threatening, its course may be intractable.

Please respond with further questions or concerns if you wish.

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Dr. Michael Salkin
Dr. Michael Salkin
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Category: Dog Veterinary
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Experience: University of California at Davis graduate veterinarian with 45 years of experience

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