Compulsive or Boredom Licking- Medical or Behavioral?

Also known as Granuloma, Acral Lick Dermatitis or Psychogenic Alopecia (often over diagnosed as being the problem, especially with cats).

Before beginning any treatment requiring prescription medications, have your vet do a thorough assessment of your dog which may include: A detailed behavior and dermatologic questionnaire to be completed by the primary caregiver. A standard diagnostic testing protocol that includes cytologic examination of skin scrapings, fungal culture of hairs, evaluation of responses to parasiticides and an exclusion diet. Assessment for atopy and endocrinopathies. A histologic examination of skin biopsy specimens to establish a definitive diagnosis as to whether pruritus is a factor.

Medical Conditions to “Rule-out”

Medical conditions that can be confused with psychogenic alopecia and must be ruled out before the diagnosis can be confirmed. These are:

Skin parasites (mites, fleas) might cause excessive irritation and thus overgrooming. For those familiar with psychogenic alopecia, the appearance is fairly typical, and parasites are fairly easy to detect, but confusion is possible in some cases unless a careful inspection is made. Skin scrapings may be needed.

Fungal infections of the skin. Skin scrapings and fungal culture should be performed. A trichogram [microscopic inspection of shed and purposely depilated hairs] can be helpful. With psychogenic alopecia it is common to find broken, barbered hair shafts rather than intact hairs with the root attached.

Hormonal conditions can be ruled out by means of appropriate blood work.

Allergies can produce a similar pattern of baldness and their possible contribution should be carefully considered. Sometimes the irritation caused by allergies can focus an anxious dog on self-grooming so that the two conditions become intertwined.

A simple rule to remember to assist in diagnosis is that allergies respond to treatment with corticosteroids whereas OCD (obsessive-compulsive disorder)does not.

The Clinical Picture

  • An anxious, nervous, perhaps overly attached dog in a seemingly stressful environment.
  • Baldness across the abdomen and inside the limbs.
  • Usually no obvious skin lesions, no ectoparasites, no medical explanation for the problem, no response to corticosteroid treatment.
  • Owner-reported excessive self-grooming – perhaps induced by obvious stress. Stressors for dogs include other dogs in the house, people who the dog doesn't like but is forced to tolerate, outside dogs, wild animals, and separation distress.
  • Breed, most likely, or history of improper socialization/early abuse/neglect.

    • Licking Paw: Our dog has a problem with her feet. She appears to be licking them raw in the middle part of her foot. Also on top of the foot is raw. What can we do? 

    Numerous theories abound regarding this almost mesmerizing habit. Some possible causes of the licking behavior include, trauma, itching, peripheral nerve irritation, boredom, allergies, skin infection, arthritis or other joint problems. Boredom, confinement, loneliness and separation anxiety have also been implicated. It is often very difficult to determine if a physical or psychological problem is causing the dog’s obsessive licking and grooming of the area. Unless a dog is exceptionally high strung and obsessive, this problem usually does not occur until the pets are five or six years old and affects both genders equally. Phlegmatic, couch potato pets seem more disposed to this disease and it is most commonly seen in Doberman pinchers and golden retrievers.

    Some possible causes of the licking behavior include, trauma, itching, peripheral nerve irritation, allergies, skin infection, arthritis or other joint problems.

    Boredom, confinement, loneliness and separation anxiety have also been implicated. It is often very difficult to determine if a physical or psychological problem is causing the dog’s obsessive licking and grooming of the area.

    Unless a dog is exceptionally high strung and obsessive, this problem usually does not occur until the pets are five or six years old and affects both genders equally. Phlegmatic, couch potato pets seem more disposed to this disease and it is most commonly seen in Doberman Pinchers and Golden Retrievers. 

    Also a fairly common problem in older, sedentary dogs with many of them being overweight as well. As pets age and arthritis and obesity make them less mobile, they spend more and more time grooming themselves – an activity that requires less energy.

    Sometimes the lesion begins as a scrape or pustule; but often there is no apparent defect at the site where licking begins. It is very uncommon for a dog to have more than one or two of these areas on his or her body. As they continuously lick these areas, hair is lost, the area becomes firm and raised and superficial staphylococcal infections often set in.

    With time, the skin of the area thickens and either gains or looses pigment. The resulting wound is called a granuloma. The center of these lesions is often ulcerated. These wounds are often unsightly but never life-threatening. Scabs rarely form because of incessant licking.

    One theory may apply for one dog and an entirely different theory may be correct for another.  In our dog's case, it was an insecurity issue coupled with boredom.

    Before acquiring her, she had been crated most of her young life for long periods of time. Boredom easily set in and with no where to go and no distractions offered, she began licking the inside of her paws so that there was no hair and the skin was raw most of the time.

    It took us almost three months to see any improvement. We helped her heal by applying Preparation H (regular or Cooling Gel) or Gold Bond Ointment. We usually keep Prep H on hand for any wounds or cuts our dogs may have since it promotes quick healing while helping to reduce pain.

    Lack of companionship is a major factor in many cases of prolonged paw licking. Called granuloma. Our dog eventually gave up the licking habit and only once in a great while would retreat back into that world of hers where she would began the licking again, closing her eyes while doing so. When we noticed this behaviour, we gently called her name and said "Summer", and she would immediately stop.

    A cost effective proven method for skin problems is Apple Cider Vinegar mixed with water. 1 teaspoon of vinegar per cup of water. Vinegar is an antiseptic which prevents the proliferation of bacteria, viruses, or yeast that trigger infection. It can also dissolve excessive fatty deposits at the surface of the skin and reduce scaly or peeling conditions. Lastly, vinegar regulates the pH of the skin. Saturate the affected area with the vinegar solution.

    Do not get near eyes or sensitive areas like the anus. Use cotton balls to apply the vinegar as these retain the moisture quite well. Unless the dog’s skin is infected, try to treat with natural methods rather than using antibiotics or steroids. Adding ½ teaspoon vinegar to your dogs drinking water will also help.

    Licking (Boredom or compulsive)

    Do not use any medication which will burn an open wound such as the wounds in the photo above. A soothing cream is needed to help in the healing process, not something which will irritate it more.

    If this skin problem has come about recently, I would investigate her diet. Good nutrition plays a major part in the overall health of a dog. She may want to change to a food with less “fillers” as these are known for causing health problems. Check the link here and see what kind of grade she gets with the dog food she is now feeding her. Dog food nutrition

    Breeds most likely to have a Lick granuloma
    Doberman Pinscher German Shepherd Golden Retriever
    Labrador Retriever Irish Setter Weimaraner
    Lick granulomas are almost always located on the front of the wrist area (carpal area)  or on the front or outside of the rear leg just above the paw (tarsal area).  They are thick, hairless, scarred sores that have ulcerated and oozing centers as a result of continuous, compulsive licking.

    Many dermatologists think that boredom is a major underlying factor in some cases of Acral Lick Granuloma. The dog's licking activity helps pass the time. Some believe that allergic inhalant dermatitis creates stress in the skin resulting in inflammation and pruritus (itching) which triggers the dog's propensity to lick at any convenient area.

    A foreign body such as a thistle spine, splinter or bee sting might start up a reaction in the skin which leads to drawing the dog's attention to the spot.

    Bone or joint pain can draw the dog's attention to the wrist or ankle area and in an attempt to alleviate the discomfort the dog licks over the top of the joint.

    Psychological stimuli such as separation anxiety, a new pet or child in the home, or neighbor dogs invading the dog's "territory" can create psychological stress.  Self stimulation such as picking out an area to concentrate on and licking for extended periods of time are a way for the dog to relieve the "stress". 

    Hypothyroidism has played a role in some cases of Acral Lick Granuloma.   Especially in Black Labs with lick granulomas it would be a good idea to have the Thyroid Gland function checked.  Thyroid medication may just be what the dog needs to have those skin lesions resolve.

    Vaccinations and boosters. Over vaccination of pets is sometimes known to cause allergic reactions. http://www.k911.biz/Petsafety/VaccineDangers.htm 

    Anytime there is a "behavior" involved, it is most important to first rule out an underlying medical reason for the behavior. If all medical concerns are ruled out, then the problem can be approached as a behavioral one, and behavior modification techniques can be employed.

    Some questions to consider: Is this a new behavior? Is it both front feet or all feet? Are there any other conditions present such as limping or swelling in the foot? A foot licking problem can start out as a medical one and later become a habit or compulsive behavior.

    Your veterinarian will be the only one to fully determine what is going on with your dog's feet, but here are some things your veterinarian will want to know and will be looking for on examination:

    • Are the feet red, swollen, or crusty/flaky?
      This could be indicative of a local irritant (such as deicer) or inflammation/infection from bacterial, fungal and/or parasitic sources. Even if the inciting cause is no longer present, constant licking and chewing can become a self-propagating cycle of continued trauma to the skin and continued inflammation.
    • Is licking present in the absence of any noticeable pathology of the feet or toes? This could be from inhalant allergies causing general itchiness, arthritis or other painful "interior" conditions causing pain in the area without visible infection, etc. on the foot.
    • Are there any irregular lumps or bumps deep between the toes or foot pads?
      Cysts or other growths or small abscesses can occur, causing discomfort and licking.
    • My dog is just licking without any visible signs of something wrong on the foot!
      Foot licking can be simply a habit behavior as well; seen when the dog is relaxing, stressed, or bored. Some dogs even chew at their nails with this type of behavior.

    Depending on what your veterinarian finds on examination, treatment to stop this behavior will be aimed at the underlying cause. For cases of allergy or infection, there are medications and/or dietary changes that can be made to assist with the problem. In situations where pain is the underlying cause, that should be dealt with directly to alleviate the licking. Growths or abscesses are usually treated surgically. Pet owners should always be vigilant about environmental hazards to feet; such as deicing compounds in the winter and very hot pavement tar in the summer.

    Behavioral modification to stop paw licking and chewing, like any behavioral modification, takes time, patience and consistency. There are several topical products that can be used to discourage this behavior (bitter, hot taste, etc.).

    Physical restraint, such as an e-collar is often used for medical conditions to allow the foot or paw to heal and thus take away the inciting cause to lick.

    Distraction is also a good technique: playing games, offering other toys and incentives to keep your dog occupied coupled with positive reinforcement will help break the cycle. If there is no infection, don't opt for the e-collar as your first choice of dealing with the problem. Most dogs do not like these and it will only add to their stress level.

    See also:  http://www.k911.biz/Petsafety/HotSpots.htm

    http://www.k911.biz/Petsafety/WormsandParasites.htm