Granulomas, Granulation tissue, Granuloma complex, Rodent Ulcers, Cold Sores, Proud Flesh, and Eosinophilic Complex are all related and are various names for pretty much the same problem.
It's not a problem we fully understand, but it's a common medical fact of life in humans as well as pets: sometimes the skin over responds to wounds, irritants, allergens, or virus' and the result is a raised, sore, inflamed, abnormal tissue reaction called a granuloma. Or many other names.
In humans and cats, these cold sore like lesions are often at muco-cutaneous junctions. This is a fancy description of where skin and mucus membranes come together. Common examples are the lips, nose, and vaginal edges.
In dogs, the most common reactive spots are on the lower limbs.
Acral Lick Granulomas, Proud flesh, & Rodent Ulcers in Dogs:
Acral lick granulomas are a common problem in dogs and refer to the raised reddened, tough, rubbery tissue that results from dogs licking the same area over and over again.
The most likely cause are underlying allergies to inhalants like pollen, dust mites and dander, food allergies or flea allergies.
Another possible cause is compulsive licking from anxiety and/or boredom, ...kind of like those of us who bite our fingernails.
Treatment: Getting granulomas to heal is a bugger. It's hard to stop dogs from licking at their sore and it's hard to get the abnormal tissue to shrink and heal.
Each vet seems to have their favorite treatment(s) because there isn't a treatment that works consistently well from case to case. But the treatment options are these:
Step 1 is a good exam to help determine underlying and secondary factors:
Are there mange mites or ringworm causing the skin to be extra sensitive?
Is there evidence of flea allergies or food allergies?
Is the patient under stress, pregnant, nervous, hyper, or kind of nuts?
Is the granuloma infected? Can you express hair shafts or pus?
Are there indications of inflammation in other places of the body like ears or frequent gastro-intestinal problems?
Your vet will investigate and consider all these things as well as determine how thick the granuloma is and whether or not it is mobile or has it grown so deep into the tissue that the tendons are incorporated into the mass.
Treatment options include
Topical steroid and antibiotic ointments
Topical enzyme preparations
Topical herbal concoctions
Topical repellants, wraps, and/or E Collars or other restraints to prevent licking
Topical DMSO is sometimes used
Any combination of the above. Every vet has their favorite and they often work... but the failure rate of using topicals alone is fairly high. So in addition to topical treatment
Laser therapy has been quite successful at our clinic but requires multiple visits
Systemic treatment with antibiotics, steroids, and antihistamines may be needed, but even this aggressive treatment often fails.
Apoquel, which will hopefully be available soon (introduced in early 2014 but the supply chain is backed up) will probably be highly successful. Apoquel basically has all the anti-inflammatory effects of steroids without the bad side effects.
Cyclosporin (Atopica) may be a successful and safer alternative to long term steroids, but such treatment is quite expensive.
Prozac or other compulsive disorder medications might be suggested and tried with success.
Be prepared for successful treatment to take 2-3 months.
Fatty Acid Supplementation might be helpful
Hypo Allergenic diets are sometimes successful
Immune modulator medications like Immunoregulin are sometimes used but their effectiveness and safety are controversial
Acupuncture may be recommended. Results?
Cryosurgery if available would probably work well on smaller granulomas but I don't have any experience with this.
Surgical removal usually works well and is sometimes needed to free up entrapped tendons, but since granulomas are usually on the lower legs, there isn't a lot of healthy skin available to suture over the surgery site once the granuloma is removed. So post op care can be complicated.
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Eosinophilic Granuloma Complex in Cats
More common names for this problem include "Rodent Ulcers", "Cold Sores", Lick Granulomas, and Eosinophilic Plaque.
As an aside, whenever you see the word "Complex" or "Syndrome" used in medicine, it often means we in the profession aren't quite sure what's causing the problem, and that's the case here.
We know cats often get these erosive lesions of the lips, genitals, and abdomen, and if the lesion is studied under the microscope that we often find lots of esosinophils (a type of white blood cell which we associate with allergies, other immune related reactions, and parasites). Here are some more things we know:
More female cats than males are affected
Neutering is not a factor
A majority of cats with lesions are either white or partly white
Blood work, Fungal Cultures, Skin Scraping, and Urinalysis are usually all normal
And there seem to be three different types of the disease:
Rodent Ulcers found on the upper lips and sometimes the neck and thigh. Often responds to steroid therapy. Often returns months later. And like our human cold sores, may or may not be associated with a herpes virus. (If it is associated with herpes, it is not contagious to people). Occasionally, lip ulcers can turn into cancer.
Eosinophilic Plaques are similar to the ulcerative type lesions except that they appear a little different, are deeper into the tissue, and are more often found on the belly.
Intradermal or Linear Granulomas are also similar to the other two types except they seem to affect mostly young cats under a year old and the lesions tend to be on the real legs and on the inside of the front legs as well as the lip. And as the name implies, they are often linear in shape as opposed to round.
The only consistently successful treatment for any of the types of granuloma complex, as far as I know, is combinations of laser therapy, surgery and steroidal therapy at fairly high doses.
Sometimes special hypo- allergenic diets are successful