Introduction:

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-reacts to irritants, allergens, or virus' and the result is a raised, sore, and red inflamed tissue.  In humans and cats, these cold sore like lesions are usually at so called muco-cutaneous junctions.  This is a fancy description of where skin and mucus membranes come together.  Common examples are the lips, nose, and vaginal lips.

In dogs, the most common reactive spots are on the carpus or wrist.

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 cause if this is usually because of underlying allergies, anything else that itches in the area, or possibly from compulsive disorders associated with boredom and/or anxieties...kind of like us biting our fingernails to the quick.

Sometimes we luck out and treatment is easy, but usually it's frustrating in the sense that the simpler treatments that are likely to be tried at first will prove to be insufficient.  So be prepared for repeated attempts.

Step 1 is a good exam looking for infection, underlying injury or bone infection, for other signs of allergies etc.  This includes a skin scraping for mites, especially in young dogs. 

Of course, if infection, mites, foreign bodies, thorns, ingrown hairs, or allergies are detected, then solving such problems will become part of the treatment plan.

Step 2  is topical treatment to reduce the itch, to help repel licking, and to treat surface infection.  I like to use a combination of prescription strength hydrocortisone cream, Malotic Ointment, a bandage, and sometimes an Elizabethan collar.  Sometimes repellents like bitter orange help.  Some vets like to add DMSO
There is an herbal treatment made by Buck Mountain Botanicals that is sometimes successful

Step 3  Systemic treatment with antibiotics, possibly steroids, and antihistamines may be needed. 
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 is often helpful

Hypo Allergenic diets are often helpful.  Click here to go to our page about therapeutic diets used to treat food allergies

Consider immune modulators like Immuno Regulin 

Consider long acting steroid therapy such as methylprednisolone injections.  Short of surgery, this is usually the most successful treatment, but then you have to weigh whether it's worth the risk of potential side effects.

Cyclosporin (Atopica) may be a successful and safer alternative to long term steroids, but such treatment is quite expensive.

Acupuncture may be recommended.  Results?

Surgical removal is sometimes needed to prevent
or treat lameness or for cosmetic reasons.

Referral for cryosurgery?





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 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 surgery and steroidal therapy at fairly high doses.

Sometimes special hypo allergenic diets are successful though.  Click here for more information



On This Page:

Lick Granulomas
Proud Flesh
Rodent Ulcers

Eosinophilic Granuloma Complex in Cats

On Other Pages:

Skin Problems in Dogs and Cats: Introduction

Bacterial Skin Problems in Dogs and Cats

Mange, Mites, Fleas, Lice, Ear Mites, and other parasites of the skin

Atopy or Allergic Skin Disease Problems

The Therapeutic Diets I recommend for Skin allergies, ear infections, and anal gland problems due to food allergies.  Sometimes successful with granulomas too.

For Serious People with Pets: My Insurance Page


Cancer in dogs and cats




Joke Time:

Dear Pets:

When I say to move, it means to go someplace else, not switch positions
with each other so there are still two of you in the way.

The dishes with
the paw print are yours and contain your food. The other dishes are mine and
contain my food. Please note, placing a paw print in the middle of my plate
and food does not stake a claim for it becoming your food and dish, nor do I
find that aesthetically pleasing in the slightest.

The hallway was not
designed by NASCAR and is not a racetrack. Beating me to the bottom is not
the object. Tripping me doesn't help, because I fall faster than you can
run.

I cannot buy anything bigger than a king size bed. I am very sorry
about this. Do not think I will continue to sleep on the couch to ensure
your comfort.

Look at videos of dogs and cats sleeping, they can actually curl up in a ball.

It is not necessary to sleep perpendicular to each other
stretched out to the fullest extent possible.

I also know that sticking
tails straight out and having tongues hanging out the other end to maximize
space used is nothing but sarcasm.

My compact discs are not miniature Frisbees.

For the last time, there is not a secret exit from the bathroom.

If by some miracle I beat you there and manage to get the door shut, it is
not necessary to claw, whine, try to turn the knob, or get your paw under
the edge and try to pull the door open.

When I exit this room, I will come out the same door I entered. In addition, I have been using bathrooms for
years.

Canine/Feline attendance has never been necessary.

The proper order is kiss me, then go smell the other animal or your butt. I cannot stress this enough. It would be such a simple change for you.

Skin Disease in Dogs & Cats

Granulomas,
& Granuloma Complex

By Roger Ross DVM