It is suggested that differential diagnosis rule-outs are investigated before considering psychogenic underlying causes.Īn additional complication is that even if the original cause is psychogenic, secondary infection is very common and will need to be treated before further evaluation. One specialist states that although environmental stress may be a factor, other causes are usually more important (Hnilica, 2011) and these are listed under the differential diagnosis. In addition to the diseases listed in the differential diagnosis, many authorities suggest that a major component in acral lick dermatitis is psychological. Whatever the initiating cause, the problem can quickly become self- perpetuating with the development of an itch-lick cycle.In one study, deep pyoderma was present in 94% of acral lick lesions (Shumaker and others, 2008). Damage to hair shafts due to the licking may penetrate into the dermis and will accentuate the deep pyoderma.Untreated cases may progress to furunculosis. Secondary infection at the later stage is very common and is a deep pyoderma.Later there is nodular ulceration, fibrosis and hyperpigmentation. Alopecia develops and the lesion becomes firm, raised, thickened and plaque-like. If untreated the lesion passes through various stages (Hnilica, 2011).Initially the lesion, in one of the sites mentioned, tends to be quite small but with increased licking slowly enlarges.
The problem tends to occur in middle-aged to older breeds such as the Doberman, Great Dane, Golden Labrador, Labrador retriever, German shepherd and Boxer, although it may occur in other breeds includingcrossbreeds.
Favoured sites for the excessive compulsive licking, which produces the lesion, are most commonly on the anterior carpal or metatarsal skin. ACRAL LICK DERMATITIS REFERS TO A SELF-INFLICTED FOCAL LESION usually found occurring on a distal (acral) extremity.