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A case of acral lick dermatitis

A look at the diagnosis and treatment of acral lick dermatitis in a Dobermann

20 June 2018, at 3:55pm

An 11-month-old female entire Dobermann presented with a skin lesion. She had been in the clients’ possession since she was seven weeks old and had an unremarkable medical and behavioural history. The lesion had developed over several weeks and the owners reported that the dog licked the area frequently. It had improved while the owners were on holiday and the dog had been cared for by a dog-sitter, but had worsened again after the owners returned. 

The owners had three young children and a busy household. The dog seemed to try to avoid the children if possible, and on a few occasions, had growled at the four-year-old boy, for which she had been verbally punished. 

Questioning revealed that the dog had knocked this boy down in the park as a puppy, that he sometimes smacked her, had fallen against her in the kitchen and had surprised her by jumping out of a Wendy house in the living room.

The dog was shut in a utility room overnight and would urinate and sometimes defecate there, for which the owners would verbally punish her in the morning. The owners felt that the dog constantly sought attention and seemed unable to relax. 

Making the diagnosis 

Physical examination identified an inflamed skin plaque, approximately 20 by 15mm, was present on the dorso-distal aspect of the left hind limb. No other abnormalities were detected on physical examination, although the bitch displayed physical signs of pseudocyesis. 

Routine biochemistry and haematology were unremarkable, as were orthagonal radiographs of the affected region. Histopathology of a punch biopsy demonstrated acral lick dermatitis with secondary furunculosis. Bacterial culture produced a heavy mixed growth including coliforms, group G streptococci and coagulase-positive staphylococci, all of which were sensitive to cephalexin. 

A diagnosis of acral lick dermatitis (ALD) due to anxiety, with secondary bacterial infection, was made. 

Treatment and follow-up

Cephalexin (Cefaseptin 600mg tablets, Vétoquinol, 900mg bid for 14 days) and cabergoline (Galastop, Ceva Animal Health, 5µg/kg sid for approximately 8 days) were prescribed to treat the bacterial infection and pseudocyesis respectively. An Adaptil diffuser was to be placed where the dog spent most of her time.

A behaviour modification programme was developed in conjunction with the owner; this included information on learning theory and advice to stop punishment for indoor toileting

A behaviour modification programme was developed in conjunction with the owner; this included information on learning theory and advice to stop punishment for indoor toileting. The owners had started putting the dog in the porch at night, which had reduced the incidence of indoor toileting. They were encouraged to continue this and a housetraining guide was supplied. A “learn to earn” protocol was discussed to increase the predictability of interactions and to reduce excessive attention-seeking. 

The clients were advised that the dog’s growling at their son was motivated by fear and, as such, punishment could worsen the problem. Interactions between the owners’ children and the dog were to be supervised and structured. 

The children were allowed to supply the treats during training sessions and the dog was taught a “drop” command, enabling her and the children to play with toys together. 

Activity toys such as stuffed Kongs and puzzle feeders were recommended to provide rewarding activities. Treatment with clomipramine (Clomicalm, Elanco Animal Health) was considered as an additional measure if the initial treatment programme did not resolve the problem. 

Two weeks after the behaviour consultation, the owners rehomed the dog to a young, childless couple who also owned a young adult male neutered German Shorthaired Pointer. It was possible to re-examine the Dobermann on two occasions after rehoming, and the lesion rapidly and completely resolved without further intervention. 

Discussion of the case 

The improvement observed when the dog was cared for by the dog-sitter suggested that a behavioural aetiology was likely. This was confirmed when other differential diagnoses (Table 1) were ruled out. The behavioural history was inconsistent with a compulsive disorder.

TABLE 1 Differential diagnoses for acral lick dermatitis
TABLE 1 Differential diagnoses for acral lick dermatitis

Pseudocyesis can present as maternal aggression, but may also cause increased arousal and anxiety, which could have been an inciting factor. Once established, inflammation and secondary infection can cause intense pruritus, resulting in maintenance of the lesion even when initiating factors have been resolved. 

It is reported that up to 70 percent of dogs diagnosed with ALD have concurrent fear or anxiety-based conditions, and Dobermanns were significantly overrepresented in a retrospective analysis of a group of ALD cases. 

While the dog’s environment was clearly the source of her anxiety, she had lived with the family since seven weeks of age and there was no identifiable increase in environmental stressors associated with the problem. It is possible that the episode of pseudocyesis increased chronic low-grade anxiety to the point of precipitating ALD in a predisposed individual. 

Due to the rapid rehoming of the dog it is unclear whether the resolution of the bacterial infection and pseudocyesis, in combination with the behaviour modification programme, would have resulted in a satisfactory outcome had she remained with her original owners.