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589.e2 Licking and Barbering Behavioral Disorders

Licking and Barbering Behavioral Disorders
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legs, and inguinal region, but other areas
BASIC INFORMATION
may have normal haircoat (e.g., head and • Dermatologic exam, including scraping and
culture (p. 1091), to assess causes such as
Definition back of neck). Alopecia is usually patchy atopy, external parasites, food allergy
Self-directed, repetitive, apparently purpose- and asymmetrical. Skin may look normal. • Microscopic exam of plucked hair (tricho-
less behaviors that may derive from otherwise • Feline overgrooming may become true gram) for evidence of shearing (broken hair
normal processes such as grooming or eating self-mutilation with cutaneous ulceration. shafts). Hair that is lost due to endocrine
but are abnormal in that they are excessive in Secondary bacterial infections may then conditions may have visible telogen bulbs.
duration, frequency, intensity, or form in the occur.
context in which they are performed • In dogs, ALG lesions appear as thickened Advanced or Confirmatory Testing
oval plaques, often with secondary bacterial • Videorecording the pet when home with
Synonyms and/or fungal infection. owners/other animals and when alone
Acral lick granuloma (ALG [p. 16]), acral • Diary of time/duration of licking/grooming,
lick dermatitis, feline hyperesthesia syndrome, Etiology and Pathophysiology to identify possible triggers and monitor
obsessive-compulsive disorder (OCD [p. 701]) • Normal adult cats spend about 30%-50% progress
of their time awake grooming.
Epidemiology • Grooming behaviors such as licking, chewing,
SPECIES, AGE, SEX and scratching serve many purposes, includ- TREATMENT
• Age of onset may overlap with social maturity ing cleaning, removal of parasites, and Treatment Overview
(dogs 12-36 months of age, cats 24-48 thermoregulation. Goals of treatment are to minimize or resolve
months of age). • Grooming can occur as a sequela to a stress- the licking, chewing, or barbering of the hair/
• Excessive licking has been reported in all ful event (e.g., after punishment, intercat skin by removing/minimizing the anxiety and
breeds, ages, and sexes. aggression) but stops with decreasing arousal. any underlying cause while treating lesions/
• In pathologic states, hair can be removed pruritus.
GENETICS, BREED PREDISPOSITION by plucking, barbering, or licking and
• Some lines of some larger canine breeds may excoriation. The plucked hair has evidence Acute General Treatment
be predisposed to ALG (e.g., Doberman, of shearing. • Treatment of any concurrent or underlying
Dalmatian, Labrador retriever, golden medical problem, such as elimination of fleas
retriever). DIAGNOSIS or resolution of food allergy
• Asian cat breeds (e.g., Siamese, Burmese, • Remove or minimize the cause of the anxiety
Tonkinese) may be predisposed to OCDs Diagnostic Overview if possible.
such as wool sucking, chewing, or eating. Diagnosis is based on a history of licking, • Provide a regular predictable routine, such
chewing, or barbering excessively that has led as feed and play at a set time each day.
RISK FACTORS to skin lesions that have no underlying parasitic,
Pain, stress, or anxiety; injury to area that infectious, or nociceptive cause. Trichography is Chronic Treatment
changes sensory function an easy way to confirm that alopecia is due to Treatment involves altering the neurochemical
hair plucking/removal, not hair spontaneously as well as the physical environments.
GEOGRAPHY AND SEASONALITY falling out. • Anxiolytic medication has proved useful in
Hot, humid weather has been associated with some cases.
acute moist dermatitis, which may be associated Differential Diagnosis ○ Tricyclic antidepressants (TCAs)
with acral lick granulomas. • Pruritic skin disease ■ Cats: amitriptyline 0.5-1 mg/kg PO
○ External parasites q 24h; average of 5-10 mg/CAT PO
ASSOCIATED DISORDERS ○ Bacterial and/or yeast dermatitis q 24h; start at the lowest dose and
• Hypothyroidism in dogs, hyperthyroidism in ○ Food allergy dermatitis increase to q 12h after 10 days if no
cats, allergies, bacterial or fungal infections, • Endocrine dermatopathies (symmetrical hair response, or clomipramine 0.5 mg/kg
nerve damage loss) PO q 24h, or doxepin 0.5-1 mg/kg PO
• Comorbidity of anxiety-related conditions • Pain associated with any condition, including q 12-24h
is common. trauma, infection, anal sac disorders, or feline ■ Dogs: amitriptyline 1-2 mg/kg PO q
lower urinary tract signs/disease 12h, or clomipramine 1-2 mg/kg PO
Clinical Presentation • Behavioral response to environmental q 12h for 2 weeks, then 3 mg/kg PO
DISEASE FORMS/SUBTYPES changes, such as moving, a new baby or q 12h, or doxepin 3-5 mg/kg PO q
• Feline: hyperesthesia, overgrooming, self- spouse, separation from owner, too many 12-24h
mutilation, and psychogenic alopecia cats in the household or area, presence of ○ Selective serotonin reuptake inhibitors
• Canine: ALG new cats in the area, changes in the social (SSRIs)
and physical environment, physical or verbal ■ Cats: fluoxetine 0.5 mg/ kg PO q 24h,
HISTORY, CHIEF COMPLAINT punishment from the owner, and inadequate or paroxetine 2.5 mg/CAT PO q 24h,
Persistent chewing, barbering, plucking, or age-appropriate physical or mental stimulation or sertraline 0.5 mg/kg PO q 24h
licking of the skin and hair ■ Dogs: fluoxetine 1 mg/kg PO q 12-24h,
Initial Database or fluvoxamine 1-2 mg /kg q 12-24h,
PHYSICAL EXAM FINDINGS • Behavioral history or sertraline 1-3 mg/kg q 24h
• Hair loss and discoloration occur only on • CBC, serum biochemistry profile, urinalysis; ○ Benzodiazepines such as diazepam 0.2-
the parts of the body that can be reached serum thyroxine level in adults (hyperthyroid- 0.4 mg/kg PO q 12h, average of 1-2 mg/CAT
by the teeth and tongue. Especially evident ism/hypothyroidism): to rule out systemic PO q 12h or oxazepam 0.2-0.5 mg/kg
in cats around the sides and rump, back disorders and before medication initiation PO q 12-24h are effective in some cats.

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