Page 269 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 269

WSVA7-0348
DERMATOLOGY
MANAGEMENT OF ACRAL LICK DERMATITIS
C. Pucheu-Haston1
1Louisiana State University School of Veterinary Medicine, Veterinary Clinical Sciences, Baton Rouge, USA
MANAGEMENT OF ACRAL LICK DERMATITIS
CM Pucheu-Haston, DVM, PhD, DACVD
Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
cpucheu@lsu.edu
Introduction:
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  lm (or sections of another collar) to the edges. Alternately, a plastic bucket can be tied to the patient’s collar. In atable or foam- lled collars will probably not be suf cient 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  brosis, 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  nances 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,  ea allergy
Deep bacterial infection
Short hair coat
Pain (osteoarthritis, trauma, chronic wound, bony sequestrum, etc.)
Hair / keratin foreign bodies
Breed
Neuropathy
Fibrosis
Neoplasia
Reinforced behavior / obsession
Fungal (Pythium, phaeohyphomycosis, Blastomyces, etc.)
Foreign body
Behavioral disorders
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