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I've got a lab mix who has been treated for lick granulomas…

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Hi there! I've got a...
Hi there! I've got a lab mix who has been treated for lick granulomas in the past, and the same spot she worked over last year has been giving her issues again this year.
I took her back to the same vet that treated her previously, and we did the same treatment protocol we did last year, but it's not helping.
It's been 3 months, and she's had treatment for fungal infection, yeast infection, viral infection, and bacterial infection, with cortisone to help with inflammation. Her foot is still a mess!
The only thing that seems to be helping is treating it like an abscess. I've been using drawing poultices and have seen Improvement, I'm keeping it wrapped so she can't keep licking at it, and giving it a little bit of air time as well.
But it just seems to be managing it instead of actually resolving it. Looking at her this morning, I'm also seeing that she's got a few red bumps on her belly. They aren't oozing, but they aren't normal.
I'm kind of at my wit's end... Do you have any suggestions? I've already taken her to two different vets. Both recommend the same treatment, the treatment that didn't do anything.
She's on a Grain free diet and gets a daily supplement (DetoxaPet) that has helped a lot.
Submitted: 4 months ago.Category: Dog Veterinary
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Answered in 1 minute by:
3/22/2018
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 4 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,873
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 4 months ago

Tabitha, I'm sorry to hear of this with Chianti. Please review my complete synopsis of acral lick dermatitis and then return to our conversation with additional questions and concerns. Can you upload a photo(s) of those "red bumps" to our conversation? You can upload photos by using the paperclip or add file icon in the toolbar above your message box (if you can see those icons on your particular device) or you can use an external app such as dropbox.com/ Please check that the photo(s) is in focus prior to uploading it.

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.

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Customer reply replied 4 months ago
I've enclosed files of the pictures of her stomach. And I've read about what you shared in regards ***** ***** lick dermatitis, but was also curious to know if it was normal for those areas to have drainage tracks that drain blood and pus?This is why I started treating it as an abscess, and have noticed that it pulls out the rupture from one of the drainage areas, that heals, and then another one opens up at a different place on the foot.Having owned and worked with horses for over 15 years, this is exactly what I see in a hoof abscess, which is why I started using the drawing poultices.All the swelling has come out of her leg, but she still has what looks like a blood blister pop up and erupt about every 2 days, it drains for about 24 hours, then starts healing and after another day or two another one pops up. Is that consistent with what you see with acral lick dermatitis?Also, thanks for your time and attention to this!
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 4 months ago

Thank you. Give me a moment to take a look...

Yes, secondary infection is very common and that's why an antibiotic chosen by a bacterial culture and sensitivity needs to be on board for many months.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 4 months ago

One photo uploaded. There's a papular rash and many quiet hyperpigmented circular areas on that skin strongly suggestive of a chronic superficial spreading pyoderma - bacterial infection usually caused by Staph. This can be addressed with a twice weekly bathing with a shampoo containing either benzoyl peroxide or chlorhexidine plus an antibiotic in the cephalosporin class such as cephalexin (which can be a good choice for her lick lesion as well). The most prominent red lesion on the skin may represent a furuncle (boil) of a deep pyoderma. Please continue our conversation if you wish.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 3 months ago
Hi Tabitha,

I'm just following up on our conversation about Chianti. How is everything going?

Dr. Michael Salkin
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