By Dr. Becker
Acral lick dermatitis, or ALD, is an injury caused by chronic licking that leads to inflammation and irritation of the skin.
If the licking occurs in one central spot that becomes thickened over time, it's called an acral lick granuloma. A lick granuloma is a firm, raised, and ulcerated area of the skin that doesn't heal because the kitty's constant attention prevents the open wound from closing. The licking and inflammation make the skin itchy, which causes more licking, and a vicious cycle of licking and itching can occur.
Acral lick dermatitis can occur in any cat of any age and either gender. The condition is much more common in dogs than in cats, but because it can occur in cats and I've had requests for a video, here it is!
In addition to itchy skin, other potential triggers for acral lick dermatitis in cats include painful conditions caused by trauma to the skin, arthritis, neuralgia, and peripheral neuropathy. A bacterial or fungal infection of the skin can also trigger itching, as can skin mites, allergies, a reaction to an environmental irritant or toxin, hyperthyroidism, and certain types of cancer.
Diagnosing Acral Lick Dermatitis in a Cat
In diagnosing your cat's skin disease, your veterinarian should first rule out any potential underlying allergic conditions. A possible allergy to fleas, food, chemicals in your cat's food, or something else in her food or environment should all be investigated.
A thorough review of potential environmental irritants – including carpet treatments, cleaning products, room sprays, and laundry detergents, as well as water and air quality should all be evaluated as potential root causes for the skin irritation.
Several skin tests are usually necessary to definitively diagnose a lick granuloma, including a deep skin scraping to check for mites and cultures to rule out infection. Biopsies of inflamed tissue may also be needed to rule out certain types of skin cancer.
The vast majority of ALD cases involve bacterial infection of the skin. It's extremely important for your veterinarian to identify the specific organism involved in order to determine the most effective treatment, especially because these bacteria are often resistant to antibiotics. In fact, 25 percent are methicillin-resistant Staphylococcus aureus, or MRSA. Lab tests to rule out internal parasites and endocrine diseases like hyperthyroidism may also be warranted.
In order for wounded skin to heal properly, your cat must be prevented from licking it. She'll need to be fitted with an Elizabethan collar (E-collar) in most cases to prevent the licking cycle from continuing. An alternative might be a light, non-stick bandage. I've actually also had success using infant T-shirts on some kitties. The basic premise is, out of sight, out of mind. Some kitties lick their bellies, and putting a T-shirt on them prevents them from getting to the site of irritation.
Keeping the wound clean is absolutely essential. I recommend disinfecting the area with dilute Betadine (povidone iodine) twice a day. Topical remedies I've used with good success for encouraging wound healing include manuka honey applied to the area twice a day, Willard Water or colloidal silver sprayed on the wound several times a day, or the essential oil of lavender diluted with some coconut oil.
Hypericum or calendula cream or tinctures can also be very beneficial. Most importantly, you've got to be able to put these solutions on your cat, and somehow prevent him from turning right around and licking them off.
Finding the Root Cause of Your Cat's Licking
To prevent future licking and skin wounds, it's crucial to identify and address the root cause for the behavior. Using topical products without identifying why the licking is occurring is fruitless.
Acral lick dermatitis is known to be a psychogenic condition in some dogs, meaning the problem is primarily behavioral and actually on the obsessive-compulsive disorder spectrum. There isn't any evidence to date that the same is true with kitties who develop the condition, but what we do know is that stress can exacerbate dermatitis in domestic cats.
One key in controlling your kitty's stress level is focusing on environmental enrichment, including feeding her at the same time every day, keeping food and water bowls and litter boxes in the same location, and keeping litter boxes very clean. I also recommend that you provide plenty of toys, lots of hiding boxes, some great scratching surfaces, and other forms of good entertainment for your cat, in addition to plenty of exercise and a species-appropriate diet.