The Nightmare Known As Lick Granuloma

I am dealing with a nightmare skin condition called lick granuloma. My sweet little Pebbles has developed this skin condition just in the last year. I have been giving her oral medications from the Veterinarian and putting a prescribed topical medication on the affected area and she goes in twice a week for laser treatments.

This is my beautiful little Pebbles
This is my beautiful little Pebbles

I know I am not the only person that is dealing with this problem, so I decided to talk about it here. I have done lots of research and consultations with our veterinarian and this is what I have learned and I want to share it with you.



  • This skin condition has many names. It is called:
  • Acral lick dermatitis
  • Acral lick granuloma
  • Acral lick furunculosis
  • Acral lick lesion
  • Acral prunitic nodule
  • ALD

According to Ian Spiegel, VMD, MHS, DACVD, it is a self-induced dermatologic condition that develops from compulsive or chronic incessant licking in one or more areas (usually foot or leg area). It is one of the most challenging and frustrating conditions for veterinarians treat. Thus my nightmare!



There are many factors that may trigger the excessive licking. These are

  • Itchy skin
  • Pain, joint or bone
  • Boredom
  • Stress
  • Obsessive-compulsive disorder

Itchy skin may be caused by things like allergies or from foreign material such as a suture, grass awn, thistle spine, a splinter, bee stinger, metal, or gravel.

Pain may be from a previous injury, mites, cancer, orthopedic disorders like arthritis, joint disease or bone pain.

Boredom may be a cause if you have an energetic dog that is left on his own for many hours of the day.

Stress can be caused by anxiety. It can be triggered by environmental things such as a new child, or pet in the home. A death in the family, or moving may be causes for anxiety also.

Obsessive-compulsive disorder can also be a factor. Animals as well as humans can be diagnosed with this disorder.

It becomes a nightmare to try to treat because the skin is so deeply affected that clear down to the base layer of the skin there can be little pockets of bacteria, broken hair follicles, plugged and scarred oil glands and dilated, inflamed capillaries.

This is Pebbles' lick granuloma
This is Pebbles’ lick granuloma

It is also believed that the condition is exacerbated by the idea that local cells or nerves become damaged and release endorphins that act not only as strong analgesics but also provide a natural “high” that just leads to more licking. It becomes a seemingly impossible cycle to break.


The main concern is infection, so that is usually the first treatment. The infection often requires 6 to 12 weeks of oral antibiotics. Because each dog is unique, what works for one may not work for another. Therefore, it may be necessary to try different treatments until you find one that works for your dog. As always, consult with your veterinarian before starting any type of treatment. Some of these treatments may include:

  • Anti-inflammatory medications
  • Topical medications
  • Electronic “bandages”
  • Physical barriers (bandages, cone collars)
  • Behavioral modification
  • Surgery or laser treatments

While lick granulomas are difficult to cure, they are usually manageable. This is rarely a life-threatening condition, although it is irritating for the dog, and as I can attest to, for the owner as well. Dogs that receive early treatment have a much better chance for a favorable outcome than dogs with advanced conditions.

Pebbles is still on antibiotics and so far the laser treatments don’t seem to be helping much. We will soon be making a trip to see our veterinarian again to perhaps try some anxiety medications. I hope we can solve this problem soon, it is distressing to me to see this open wound on her tiny little paw and watch her excessively lick it. I am hopeful that we will find the right treatment and thankful that we at least began treatment early.

UPDATE: June 2016

Believe it or not, it is 6 months later and we are still dealing with it. Every time we get it healed, she continues to lick it and continues to re-infect it. When I wrote this 6 months ago I called it a nightmare…… now I realize how true that statement really was. Even veterinarians don’t know how to cure it for good. Since nothing else has worked, I’ve been putting a topical ointment from the vet on it every morning and afternoon and again in the evening and she has to wear her Elizabethan collar every day (some call this a “collar of shame, I think that name is shameful! Why should she be ashamed?). Then I wrap it every night so she won’t have to wear the collar to bed. The wrap won’t work for during the day because she just keeps licking and biting it until she gets it pulled down far enough she can lick the spot….. or if you don’t wrap the entire leg, she starts a new one.

UPDATE: June 2017

Well, after 1 1/2 years her lick granuloma is finally gone with now permanent skin or nerve damage. It took a combination of antibiotics and a concoction that my vet mixed up with some kind of steroid. We put that on her granuloma and wrapped it twice a day.

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