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16 Acral Lick Dermatitis

secondary bacterial infection has been Recommended Monitoring
eliminated. With oral isotretinoin therapy: pretreatment
VetBooks.ir metronidazole gel, other topical medications chemistry profile, and urinalysis. Repeat
• Others: sulfur-salicylic acid shampoos, 0.75%
measurement of tear production, CBC,
monitoring every 1-2 months.
containing clindamycin, erythromycin, or
tetracycline (cats)
Systemic treatment: PROGNOSIS & OUTCOME
• In more severe cases, secondary bacterial
infection can be treated with appropriate • Canine acne carries a good prognosis, with
systemic antibiotics for 3-6 weeks. Good many dogs achieving a permanent cure. Some
empirical choices include cephalexin 22 mg/ dogs require lifelong topical therapy.
kg PO q 8h or 30 mg/kg q 12h (dogs) • Feline acne also has a good prognosis, but
and clavulanic acid–potentiated amoxicillin lifelong intermittent or continuous therapy
13.75-25 mg/kg PO q 12h (cats, dogs). In is often needed.
ACNE: FELINE Comedones (blackheads) on the chin cats hard to pill, cefovecin 8 mg/kg SQ q 2 • In severe cases, active lesions can resolve with
of a cat with uncomplicated acne. (Courtesy Dr. Manon weeks can be considered. scarring.
Paradis.) • Refractory feline cases may benefit from
systemic isotretinoin (2 mg/kg PO q 24h; PEARLS & CONSIDERATIONS
Caution: severe teratogenicity in animals
Acute General Treatment and humans); in responsive cases, improve- Comments
• Choice of treatment will depend on the ment should be seen in 1 month. • Owners should avoid expressing the lesions
severity of the disease. because of possible internal rupture of the
○ Dogs: minimize trauma to the chin. Chronic Treatment hair follicles, inducing local inflammation.
○ Cats: clipping the affected area can increase For recurring lesions, topical medication can • Benzoyl peroxide–containing medications
efficacy of topical treatment. be used as needed for long-term therapy. can bleach carpets and fabrics.
Topical treatment: • When not secondarily infected, feline acne
• Mild lesions can be controlled with applica- Possible Complications is a cosmetic disease that does not affect the
tion of benzoyl peroxide shampoo or gel • Localized irritation with topical preparations cat’s quality of life. It can be left untreated.
(2.5%) q 24h until resolution, then 1-2 times containing benzoyl peroxide or tretinoin
per week as needed. Chlorhexidine shampoo • Nephrotoxicity due to ingestion of the Technician Tips
or wipes can also be useful in secondarily excipient polyethylene base in mupirocin The owners should be instructed to stop the
infected lesions (dogs). ointment is unlikely with use of small topical treatment and contact the medical team
• Phytosphingosine-containing products amounts of the product on a localized skin if the patient develops worsened local irritation.
(Douxo Seborrhea Spot-on) applied twice area. The product should not be licked for
weekly can sometimes be useful in cats. 5-10 minutes after treatment. SUGGESTED READING
• Mupirocin or fusidic acid ointments or • Chronic topical corticosteroids can cause Miller WH Jr, et al: Bacterial skin diseases. In Muller
creams may be applied q 12-24h until resolu- adrenal suppression and local skin atrophy. & Kirk’s Small animal dermatology, ed 7, St. Louis,
tion (3-4 weeks). These medications may be • Oral isotretinoin can induce side effects of 2013, Elsevier Mosby, p 201.
considered initially or if there is a lack of diarrhea, anorexia, vomiting, conjunctivitis, AUTHOR: Nadia Pagé, DMV, MSc, DACVD
response to treatment with the above options. increased liver enzyme levels, hypertriglyc- EDITOR: Manon Paradis, DMV, MVSc, DACVD
• In cats, tretinoin 0.01%-0.025% cream or eridemia, and hypercholesterolemia. It is
lotion may be used in refractory cases q 1-3 teratogenic. With chronic use, skeletal
days for 4 weeks, then as needed. abnormalities are a concern. It can possibly
• Glucocorticoid creams may temporarily be harmful in cases of accidental human
be needed to reduce inflammation once ingestion.

Acral Lick Dermatitis Client Education
Sheet

BASIC INFORMATION Epidemiology Clinical Presentation
Definition SPECIES, AGE, SEX HISTORY, CHIEF COMPLAINT
• Multifactorial condition characterized by a Dogs, adult • Excessive, compulsive licking at a focal area
firm, ulcerative, or alopecic cutaneous plaque on a distal limb, resulting in a firm, alopecic,
induced by excessive, compulsive licking of GENETICS, BREED PREDISPOSITION eroded or ulcerated plaque or nodule.
the lower portion of a limb • Predisposed breeds: Doberman pinscher, • Occasional history of trauma or joint disease
• Acral (Greek: akron, “extremity”): pertain- Labrador retriever, Great Dane, Irish setter, in the affected area
ing to the extremities of peripheral body golden retriever, German shepherd
parts PHYSICAL EXAM FINDINGS
RISK FACTORS • Usually only a single lesion is noted. Most
Synonym Underlying conditions include allergic disease common sites include dorsal carpus, meta-
Lick granuloma and bacterial infection. carpus, or metatarsus.

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