I think Ella is getting a lick granuloma

[Chewbecca]

She has normally dry elbows and calloused elbows "concrete elbows", but lately she's been REALLY licking her right elbow. She's broken open some of the skin. I had been using bag balm on it, hoping that it was just unusually dry skin, but she really laid into licking it last night. I used the prescription lick granuloma spray the vet gave us last year when she had a lick granuloma and I tried to wrap it. BUT...wrapping an elbow is difficult. The wrap keeps slipping off her elbow. Plus, when I wrapped it, she went all straight legged and acted like she couldn't bend her elbow (which she COULD because I had Ben bend her elbow to make sure I hadn't wrapped it too tightly).

Any suggestions on wrapping it?
I'm afraid if she doesn't stop licking, I'm going to have to take her to the vet on Saturday. We gave her a bath Sunday and that usually clears up any itchies for her, but she's STILL licking that spot AND her paws and legs. I've also been giving her Benedryl. But she's still licking.

[SizzleDog]

When you wrap the elbow, are you going over the shoulder? That's the best way to wrao an elbow - wrap it up, then sling the bandage over the dog's back then wrap the other elbow to hold the whole thing in place.

GOOD LUCK!!!

[Chewbecca]

Here's a pic:
The circled part is the part of her elbow that has the increased baldness and redness, the other part is where her elbows are usually bald (concrete elbows). It ALL looks pinker and more irritated, though.
http://i203.photobucket.com/albums/aa248/chewbucket/P1040692.jpg

[milos_mommy]

ick, poor Ella.

If benedryl, bathing, and the spray isn't working, it must REALLY be bothering her. It might be a hot spot, it doesn't look scabby or rough enough to be a granuloma...

you could try putting cortisone on it. That should stop the itch.

And give her hugs from me!!

[Herschel]

I don't think any sort of wrap is going to work effectively because it is on her elbow. Could you try having her wear a long sleeve shirt just to cover the area?

Could you tell me what is in the granuloma spray? Is it just a topical antibiotic + anti-inflammatory? If so, which ones? I would say have her wear a shirt/fleece and place a wrap under that. At this point, I'm not sure "granuloma spray" is your best course of treatment.

[Chewbecca]

It's Butler GentaSpray Topical Spray-gentamicin sulfate with betamethasone valerate veterinary topical spray.

I made a vet appt. for her on Saturday. Remember, that probably looks a lot worse to you guys because you're probably not used to seeing concrete elbows. Only part of that is where she is licking.

I can probably keep her in her fido fleece coat or her hoodie.

[SizzleDog]

Is this a normal thing Rebecca? Because there is a neat company called DogLeggs that can help: http://www.dogleggs.com/

More specifically, this product: http://www.dogleggs.com/files/adjustable.cfm

[Chewbecca]

She has never gotten a lick granuloma on her elbow before, but she had one on her forepaw last year. The elbow is a new area.

Those things look awesome! And for almost $100 they'd better be!
Thanks for the link!

[Herschel]

OK. The spray is an antibiotic + anti-inflammatory. A lot of prescription eye drops contain the same drugs (dexamethasone rather than betamethasone).

If you go to your vet, they are probably going to give you more of the same (antibiotics + anti-inflammatory) and potentially systemic antibiotics. (Easier to treat from the inside, seeing that she keeps licking the outside) Personally, I would skip the vet on this one and handle it from home.

The Merck Veterinary Manual has some great information about acral lick granulomas and other pyodermas:
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/70900.htm&word=acral%2cdermatitis%2ccanine

Treatment:
The primary treatment of superficial pyoderma is with appropriate antibiotics for ≥21 and preferably 30 days. All clinical lesions (except for complete regrowth of alopecic areas and resolution of hyperpigmented areas) should be resolved for at least 7 days before antibiotics are discontinued. Chronic, recurrent, or deep pyodermas typically require 8-12 wk or longer to resolve completely.

First-time bacterial pyoderma can be treated with empiric antibiotic therapy such as lincomycin, clindamycin, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim-sulfadiazine, chloramphenicol, cephalosporins, amoxicillin trihydrate-clavulanic acid, or ormetoprim-sulfadimethoxine.

Amoxicillin, penicillin, and tetracyline are inappropriate choices for treating superficial or deep pyodermas because they are ineffective in 90% of these cases. Fluoroquinolones should not be used for empiric therapy. Severe deep pyoderma, recurrent pyoderma, or first-time bacterial pyodermas that do not respond to therapy should be treated based on culture and sensitivity.

Topical antibiotics may be helpful in focal superficial pyoderma. A 2% mupiricin ointment penetrates skin well and is helpful in deep pyoderma, is not systemically absorbed, has no known contact sensitization, and is not used as a systemic antibiotic that would increase the likelihood of cross-resistance. It is not very effective against gram-negative bacteria. This ointment should not be used in cats with any known or suspected history of renal disease because the preparation contains propylene glycol. Neomycin is more likely to cause a contact allergy than other topicals and has variable efficacy against gram-negative bacteria. Bacitracin and polymyxin B are more effective against gram-negative bacteria than other topical antibiotics but are inactivated in purulent exudates.

Attention to grooming is often overlooked in the treatment of both superficial and deep pyoderma. The hair coat should be clipped in patients with deep pyoderma and a professional grooming is recommended in medium- to longhaired dogs with generalized superficial pyoderma. This will remove excessive hair that can trap debris and bacteria and will facilitate grooming. Longhaired cats usually benefit most from having the hair coat clipped.

Dogs with superficial pyoderma should be bathed 2-3 times/wk during the first 2 wk of therapy and then 1-2 times until the infection has resolved. Dogs with deep pyoderma may require daily hydrotherapy. Medicated shampoos should be prediluted 1:2 to 1:4 prior to application to facilitate lathering, dispersal, and rinsing. Appropriate antibacterial shampoos include benzoyl peroxide, chlorhexidine, chlorhexidine-ketoconazole, ethyl lactate, and triclosan. Shampooing will remove bacteria, crusts, and scales, as well as reduce the pruritus, odor, and oiliness associated with the pyoderma. Clinical improvement in superficial pyodermas may not be evident for a least 14-21 days, and recovery may not be as rapid as expected.

I think you should go with the recommendation of washing the area with an antibacterial solution (such as the ones recommended). Benzoyl peroxide (acne medications), chlorhexidine (in medicated mouthwash), and triclosan based soaps should be readily available at your local drug store.

Then, treat with a topical antibiotic. Merck didn't mention Gentamicin specifically, but they did say that neomycin (another topical aminoglycoside) is not usually effective. The spray that you are using will help reduce the inflammation but I doubt it will treat any infection.

[Chewbecca]

Thank you, Hershel! I appreciate this and I will have to read it more when I have more time. Unfortunately, before I read this post I had already made a vet appt.

I am happy to report, NO ITCHING LAST NIGHT. YAY!!!!!!!!

I bought a ton of vet wrap.

[Chewbecca]

Ella's elbow is a deep pyoderma. She also has a small derma mass on her right side (2 cm). She's on simplicef for 3 weeks, and if that doesn't clear it up, then I'm going to have them do some skin testing.

[Caren+Bailey]

Poor thing :( I hope it heals up for her soon!

[Herschel]

Ella's elbow is a deep pyoderma. She also has a small derma mass on her right side (2 cm). She's on simplicef for 3 weeks, and if that doesn't clear it up, then I'm going to have them do some skin testing.

Thanks for the update. Hopefully it will clear up soon. The Merck manual says that cephalosporin (Simplicef) should do the job.

Are you washing the site of infection daily (as per the MVM)?

Good luck!

[Chewbecca]

well, no. Oops! I'm a bad mom-lady!
But I am spraying it daily and when I spray it, she doesn't lick at it throughout the day. The licking mainly only occurs at night. I don't know why.

[bubbatd]

I had a foster in that licked an area like this ..... I think it was mostly a nervous reaction . I put Goldbond powder on it .... whether it was that or TLC it cleared up .

[Herschel]

I had a foster in that licked an area like this ..... I think it was mostly a nervous reaction . I put Goldbond powder on it .... whether it was that or TLC it cleared up .

Haha. That is brilliant. I could totally see myself doing that.

I probably try to treat way too many things at home. :)

[nuvetmarie]

:(
I sure do like a product called EMT gel.. It is a collegen product that sits on the hot spot??? area for 3-4 days.. ( all natural) Makes a protective area.
***you can get it from Revival Heath... ( on the net)
This will help the area to heal. This will NOT stop what allergens are hitting her.

My web site has some info on NuVET Plus - another supplement that is great for allergies ... I am a rep for them.. Many of my doggie hotel customers are on this product. ( about .54 cents per day)
I am putting in a PLUG for NuVET only because I know it would help.
Guarnateed or your money back..

Anyway, She could be allergic to Environmental allergens beside food allergien.
NuVEt will help her to build the immune system and fight off the allergies..

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