Page 269 - WSAVA2017
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C. Pucheu-Haston1
1Louisiana State University School of Veterinary Medicine, Veterinary Clinical Sciences, Baton Rouge, USA
CM Pucheu-Haston, DVM, PhD, DACVD
Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
Acral lick dermatitis (ALD) can be a very frustrating challenge for the small animal practitioner. It’s easy for clients and veterinarians alike to lose patience with the often slow process of workup and therapy. The purpose of this lecture is to present some tips that I have found useful in the management of acral lick dermatitis.
Factors that may contribute to ALD(1)
Tip one:
Prevention of further damage and treatment of secondary infection are the two most critical factors determining treatment success or failure.
Self-trauma creates a “damage à itch/discomfort à lick
à more damage” cycle that can be almost unbreakable
if the patient is allowed to continually traumatize the lesion. Physical intervention to prevent self-trauma will
be required initially, although adjunctive medications (see below) may make the job easier. The most commonly used method is an Elizabethan collar, although the animal must be observed to make sure that they cannot reach around the collar or scrape the leg on the collar edge. Collars can be extended by taping X-ray film (or sections of another collar) to the edges. Alternately, a plastic bucket can be tied to the patient’s collar. Inflatable or foam-filled collars will probably not be sufficient on their own, but may be helpful when placed behind
an Elizabethan collar to prevent it from being shoved
backwards. The temptation to remove the collar early must be resisted, as dogs can undo weeks of healing in a single afternoon. Ideally, the collar should be kept on (except for feeding) until the lesion is re-epithelialized and nearly resolved.
Almost all ALD are complicated by secondary bacterial infection. This infection is perpetuated by the presence of hair foreign bodies and extensive fibrosis, both of which serve to create protected areas for bacteria. Antibiotic selection is best based upon the results of sensitivity testing. Ideally, the skin should be aseptically prepared and a deep skin biopsy obtained for culture. If finances are an issue, the lesion may be cleaned and squeezed to extrude infected debris. Prolonged courses of antibiotics (2-6 months or more) are often required. As a general rule, patients should be continued on antibiotics at least until the lesion is completely resolved.
An Urban Experience
   Primary causes
 Perpetuating causes
 Predisposing causes
  Allergy: Food allergy, atopic dermatitis, flea allergy
   Deep bacterial infection
    Short hair coat
  Pain (osteoarthritis, trauma, chronic wound, bony sequestrum, etc.)
 Hair / keratin foreign bodies
 Reinforced behavior / obsession
  Fungal (Pythium, phaeohyphomycosis, Blastomyces, etc.)
   Foreign body
   Behavioral disorders

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