Acral Lick Dermatitis Flashcards
What is another word for lick granuloma
Acral lick dermatitis
Where do lick granulomas typically occur
peripheral / extremity
-tarsal, metatarsal, tibial
-carpal, metacarpal, radial
-focal/multifocal
What causes acral lick dermatitis
self-induced
results in pyogranulomatous fibrosis/scarring
What does acral lick dermatitis look like
plaque
chronic
thickened
raised
variable ulceration
variable hyperpigmentation
What breeds commonly get acral lick dermatitis
doberman pinscher
great dane
labrador/golden retriever
irish setter
german shepherd dog
What is the triad of acral lick dermatitis
PRimary
Secondary (infection, deep)
Behavioral
What are primary causes of acral lick dermatitis
-Allergy *
-Foreign Body
-Pain (osteoarthritis)
-Neuropathy
-Atypical infection (fungal, mycobacterial)
-Neoplasia
-Psychogenic (Doberman)
Secondary issues with acral lick dermatitis
deep pyoderma
furunculosis
What causes behavior acral lick dermatitis
intial stimulus to lick
endorphin release
epidermal proteaseas
stimulate naked nerve endings (pruritogenic)
How do you diagnose acral lick dermatitis
Visually distinctive
Cytology (squeeze it)
History of allergy
Biopsy
Radiographs
How do you treat primary acral lick dermatitis
1) Stop itch/lick cycle
-Topical deterrent (HEET, Bitter Apple)
Frequent administration required
-Barrier
2) Steroids, Apoquel, Cytopoint, Cyclosporine, Topicals (Synotic, triamcinolone, betamethasone)
A Jak-Stat inhibitor
IL-2, 4,6,13,31
short lived
moderate anti-inflammatory
Apoquel (Oclactinib)
Monoclonal antibody
IL-31
long lived
mild anti-finallamtory
4 weeks duration
Cytopoint
Calcineurin inhibitor
T cells
Delayed onset (4-6 weeks)
Potent anti-inflammatory
Atopica (Cyclosporin)
How long do you treat acral lick dermatitis
4-6 weeks (deep)
2 weeks beyond completion
Culture
Topical (Mupirocin, Silver Sulfadiazine, Animax)
How do you treat behavioral acral lick dermatitis
-TCA (amitriptyline, clomipramine)
-FLuoxetine
-Gabaepntin
-Endorpin substitute (hydrocodone)
-Endorphine blocker (naltrexone)
-Anxiolytics (diazepam, trazadone)
-Behavioral consultation
Other non-medical treatments for acral lick dermatitis
Surgical removal
Radiation therapy
Gabapentin
Cryosurgery
Cold laser therapy
Acupuncture
Phovia (Vetoquinol)
What is the prognosis of acral lick dermatitis
Fibrosis likely (alopecia)
Can lead to furunculosis long term (fibrosis)
primary disease an often not be cured
long term management often required
