CHAPTER 14 BEHAVIORAL OR SELF-INJURIOUS DERMATOSES 233
THERAPEUTICS
Diagnosis and management of underlying causes required for successful control of
symptoms.
Glucocorticosteroids and antihistamines may be helpful in allergic patients; not rec-
ommended for use with acral lick dermatitis; see specific chapters regarding use of
these medications.Response requires lengthy treatment periods.
Relapses not uncommon; maintenance therapy necessary.
Behavior-modifying medications are adjunctive therapy.
Mechanical devices (e.g., collars, bandages) to prohibit further damage to the skin
and allow healing often required at least initially; not a long-term solution.
For acral lick dermatitis:
Bandages with embedded electric contacts may dissuade licking
Intralesional injections not useful for larger or multiple lesions
Surgical excision (including by laser): removal of exuberant tissue useful only
if primary disease is identified and resolved; severe postoperative complications
possible
Therapeutic laser therapy not supported by controlled studies.Behavior Modification
Reduce stress.
Identify and remove sources of conflict, triggers, fear, boredom, or frustration.
Provide outlets for alternative behaviors such as exercise and stimulation with toys.
Increase calm and social interaction with owner.
Use operant conditioning by rewarding positive behaviors; avoid punishment or
attention for the self-injurious behavior.
Increase supervision to reduce opportunities for the behavior; distract rather than
punish the behavior when it occurs.
Drugs of Choice
Acral lick dermatitis:
Topical:
Rarely effective as single therapy
Fluocinolone-DMSO combined with flunixin meglumine or antibiotics
Capsaicin: may decrease reinforcing sensation and discourage licking
Mupirocin ointment
Systemic:
Long-term antibiotics based on culture and sensitivity testing (e.g.,
cephalexin 22 mg/kg BID)
May be required for several months
Pulse-dose therapy may be necessary: see chapter on antibiotic stewa-
rdship.