Goals of Treating “Hot Spots”
Both the medical and behavioral components of hot spots must be addressed for treatment to be entirely successful. The goals of treating hot spots are to eliminate inflammation and itchiness, resolve any primary or secondary bacterial, viral or fungal infections, eliminate pain and correct the dog’s self-destructive licking and chewing behaviors. In most cases, the dog will need to be physically restrained (such as with an Elizabethan or “lamp shade” collar) to prevent it from licking the hot spot site until it is well on its way to healing.
Treatment Options for “Hot Spots”
In the best of circumstances, a dog with a hot spot will have an identifiable – and curable – primary allergic, infectious or other skin, joint or systemic condition that is triggering its compulsive licking behavior which is causing the lick granuloma. Because hot spots are extremely painful, the dog normally will need to be sedated or even placed under general anesthesia to go through the initial treatment steps. The area will be clipped and cleansed with an appropriate veterinary shampoo. If a bacterial infection is present, aggressive oral and topical antibiotics can be prescribed. Steroids such as prednisone, or non-steroidal anti-inflammatory drugs, may help to reduce swelling, itchiness and irritation at the hot spot site; these can be given orally or applied topically in the form of creams or powders. If environmental allergies are suspected, antihistamines can provide some relief. The veterinarian can inject certain medications directly into the hot spot to try to alleviate pain and itchiness, although their effectiveness is somewhat controversial.
Analgesic drugs can be used for pain relief. In addition, there are a number of prescription pharmaceuticals, including anti-depressants and psychotropic drugs, which can help with the behavior modification process. Appropriate flea and tick control are invaluable if the hot spot is related to external parasite infestation or allergy. Normally, hot spots are not removed surgically, because it is difficult to close an incision site on the top of the wrist and paw. Bandaging and physical restraint (Elizabethan collars, BiteNot collars, others) are almost always necessary, at least early in the course of treatment. Newer treatments, including laser therapy and cryosurgery, may be less likely to cause wound breakdown and pain. They also can destroy nerve endings, helping to break the itch-lick-chew cycle.
Above all, owners should know that lick granulomas are not easy to treat. It requires time, patience and plenty of attention and commitment on the part of the owners to have a successful resolution of this disorder. Unfortunately, recurrence is fairly common.
The prognosis for dogs with acral lick dermatitis varies from good to guarded. Dogs with identifiable and treatable underlying dermatological disorders have a much better prognosis than do those whose licking behavior and lesions can not be attributed to a primary medical condition.