Podcast: Lick Granulomas With Dr. White

Acral lick lesions typically originate from an underlying pruritic or painful stimulus, and identifying that trigger is essential to resolution.

Acral lick dermatitis is classified as a deep pyoderma and requires antimicrobial therapy of longer duration than is typical for superficial skin infections.

Superficial swab culture and tissue culture results can differ substantially. Surface sampling alone should not be used to guide antimicrobial therapy.

Surgical excision of acral lick lesions is generally not recommended, even when the mass appears well-circumscribed, due to risk of complication (ie, surgical site dehiscence) and recurrence.

Fluorescent light therapy is an emerging adjunctive treatment, associated with a reduction in pyoderma healing time.

Acral lick dermatitis is not primarily a psychological condition. Behavioral medications such as fluoxetine should not be used as first-line therapy. Use is warranted only after the primary trigger has been identified and addressed, with long-term control of the underlying disease central to preventing recurrence.

Client education and realistic expectation-setting are key to successful resolution, including preparing owners for the extended timeline and multi-modal approaches required to fully break the itch-lick cycle.