LICK, LICK, LICKING (Acral lick granuloma)

28th Jun, 2018

My dog, Shelly, is constantly licking a sore place on her front leg. I’ve tried using various salves, but she just licks them off. The wound seems to be getting bigger the more she licks, and I really don’t know what to do.

Sheldon van Zyl, Jeffrey’s Bay

Claire Atkinson M.A. (Cantab.), Qualified Dog Behaviourist and Certified Tellington Touch® Practitioner, addresses this dog behaviour and what you can do about it…

This is a condition that, at present, has no quick-fix solution. It’s called acral lick granuloma. Quite a mouthful for a condition that frequently arises – your dog is incessantly licking a particular spot, usually on the extremities (acral) and granuloma (the nature of the lesion) forms. The causes and treatments are varied.

Because there are so many variables, treatment is usually a bit of trial and error to find the best remedy for this irritating and painful condition. There’s no specific recipe that guarantees a cure. Meanwhile, the dog keeps licking and the lesion becomes inflamed and infected.

Note that this is not the same as a “hot spot”.


In order to treat the condition, we need to explore possible causes. Try keeping a log of when it gets worse or better to help you narrow it down.


In some cases, the cause is simple – something, such as a thorn or a grass seed, has become embedded on the paw or lower leg. This results in pain and irritation in the affected area and the dog licks it constantly in the hope of removing it.

There may also be pain in the bone or joints of the affected limb due to arthritis or an untreated injury. Older dogs may develop this condition as a response to arthritic pain.


Some breeds seem to be more likely than others to exhibit this condition. These include

Doberman Pinschers, German Shepherds, Golden Retrievers, Labrador Retrievers, Irish Setters and Weimaraners.


We can describe this as either obsessive-compulsive disorder (displacement behaviour) and/or a general anxiety disorder. Here, the dog receives some gratification from the experience, even though it’s self-harming.

Anxiety disorders also need to be explored, as these can give rise to this behaviour as a release to help allay the anxiety. Separation anxiety is often a factor to consider, as well as boredom.


Hyperthyroidism is the excessive secretion of thyroid hormones. While more common in cats than in dogs, there’s often a loss of weight, increase in appetite and a raised heart rate. Some breeds, particularly Black Labradors for example, are prone to this form of the condition.

Diet and Nutrition

Often, a change in diet may eliminate the problem. Kibble (pellets), for example, contains a high level of carbohydrates. Without getting into a great debate, a diet of either raw food (high protein) or homemade food with a high protein content, often provides positive results.

A recent study indicated that up to 70% of dogs with acral lick also presented digestive problems. 

How to help your dog

If you’ve read this far, you (along with vets and behaviourists) may be asking: “Well, if we know the causes, isn’t there a quick fix to get it sorted?” Sorry, no. All the treatments that are used tend to need weeks, or in serious cases, months to clear up the problem. There are three areas in which we need to concentrate: mechanical, medical intervention and/or natural remedies, and behavioural.


The use of Elizabethan collars (“cone”) or bandaging to help the lesion heal by stopping the dog from licking it is not particularly effective. Any dog will try to remove bandages, and even if splinted, the dog will simply find another area to lick and the result is two granulomas.

The “E” collar (or similar) is a difficult form of management and is stressful for both owner and dog. It may be used as an interim measure but it’s not useful when long-term treatment is required.


Most vets will probably suggest a long-term treatment (6 to 12 weeks) with oral antibiotics, depending on the nature of the granuloma and the length of time it’s been left to develop. If there’s little or no response, the vet will most likely look towards allergy identification and treatment.

The use of Manuka honey is also used for its powerful healing and anti-bacterial properties. That’s if it can be applied for long enough before it’s licked off!

Keeping the wound clean is an obvious point, but some shampoos (even those specifically for dog use) can irritate a wound and the area should be avoided if bathing is a must.

Recently there’s been some success with the use of laser treatment, especially where the wound has caused thickening of scar tissue, as the laser vaporises the affected tissue, enabling deeper treatment of the granuloma. 


If stress is likely the basic cause of the problem, vets may prescribe a stress calming medication in association with behavioural treatment. The causes of the behaviour are assessed carefully (there’s usually a combination of factors to consider) and a suggested treatment plan is then worked out for the owner.

As with humans, animals may resort to self-harming as a way of releasing stress. The big, wide world out there presents many stressors for nervous or fearful dogs, and if there’s an overload, the dog may choose this way of helping it to manage the stress.

Our aim, therefore, is to keep the dog below the point at which the stressors trigger and overload the system (leading to flight/fight/flee/freeze behaviour) and it takes a while for the physiology to adjust back to normal.

As you can see, there are a lot of factors to take into account when treating the condition, hence the “trial and error” exploration that may be necessary before the root cause(s) can be treated. Your vet is the best person to help you, along with a behaviourist who is trained to look beyond the obvious. Please consult a professional for assistance.