Lick Granulomas: A New Treatment for a Frustrating Condition Case

Sponsored by Vetoquinol

Lick granulomas are a frustrating and not uncommon condition in dogs, constituting nearly 3% of dermatology cases seen in general practice.¹ Conventionally, treatment has involved a combination of therapies, including antibiotics, anti-inflammatories, and psychogenic drugs, all intended to promote healing and prevent self-trauma. Fortunately, new advances are providing convenient options for the management of canine lick granulomas.

Case Study: The Role of Phovia in Lick Granuloma Treatment

A 2-year-old neutered male Husky crossbreed (Figure 1) was presented for a 6-month history of a nonseasonal pruritic lesion on the dorsal right carpus.

FIGURE 1

The patient on presentation. Image courtesy of Dr. Amelia White 

His owners reported that the lesion waxed and waned; it was initially flat and erythematous but had gradually become crusted and raised. The owners reported a pruritus score of 4/10 on a visual analogue scale, as well as a history of superficial bacterial folliculitis that resolved with antibiotics. The dog spent most of his time indoors (while his owners were at work) but was regularly exercised outdoors. He was up to date on vaccines and flea, tick, and parasite prevention and lived with another dog that had no dermatologic concerns.

On examination, a single raised, firm, well demarcated nodule (2.7 cm × 1.8 cm; depth, 0.4 cm) was noted on the dorsal right carpus (Figure 2). The nodule exhibited hypotrichosis, erythema, and hemorrhagic crusting. Focal hyperpigmentation was noted distal to the lesion. No other dermatologic abnormalities were observed. Orthopedic examination of the carpus and the remainder of the physical examination were unremarkable.

FIGURE 2

Lesion on presentation. Images courtesy of Dr. Amelia White 

Fine-needle aspiration revealed pyogranulomatous inflammation, and skin scraping did not reveal parasites. The patient was diagnosed with a suspected acral lick granuloma secondary to mild allergic dermatitis. The owner declined carpal radiography, biopsy, and bacterial culture and susceptibility testing due to the mild nature of the clinical signs and elected to begin treatment.

The lesion was clipped and cleaned for visibility, and Phovia fluorescent light therapy was administered. The dog received 2 treatments, each lasting 2 minutes, with a 10-minute break between treatments. No other therapies were prescribed, except for an E-collar.

The owners reported that the lesion was 50% less inflamed within 12 hours; at 24 hours, they removed the E-collar because the dog was no longer bothering the lesion. At the 1-week recheck, the lesion was significantly improved, with a decrease in size and visible hair regrowth (Figure 3).

FIGURE 3

The lesion 1 week after receiving Phovia. Image courtesy of Dr. Amelia White 

The lesion completely resolved by the 2-week recheck (Figure 4), but weekly treatments were continued for a total of 5 treatments due to the initial deep nature of the lesion.

FIGURE 4

The lesion 2 weeks after receiving Phovia (left) and 28 days after receiving Phovia (right). Images courtesy of Dr. Amelia White 

Treatment for Lick Granulomas

Phovia is a 2-part system that uses an LED lamp and chromophore gel. When used together, these components produce multi-wavelength fluorescent light energy that simultaneously targets multiple layers of the skin. This fluorescent light energy promotes skin regeneration and rapid healing. Phovia is typically administered twice weekly; these treatments may be spread out or performed on the same day. The duration of therapy depends on the condition to be treated. Phovia can be used for canine and feline dermatologic conditions, including surgical incisions, perianal fistulas, interdigital furunculosis, and superficial and deep pyoderma. Depending on the case, Phovia may be used alone or in conjunction with systemic antibiotics. In a study, clinical resolution was achieved in 88% of dogs with deep pyoderma after 8 weeks of Phovia combined with systemic antibiotics as compared with 35% when antibiotics were used alone.²

In this case, Phovia alone was used to successfully treat a lick granuloma, with complete resolution observed within 2 weeks of the first treatment. No oral medications were needed, reducing stress for the client and patient while also eliminating potential concerns about owner compliance. Given the suspected underlying allergic etiology of the lick granuloma, atopy and food allergies were discussed with the owners. The owners were also given recommendations for avoiding daytime boredom while the dog was left home alone. The patient was followed for 11 weeks, and no evidence of recurrence was noted. The outcome of this case demonstrates the ease and effectiveness of Phovia as a promising new therapy for acral lick granulomas.