Case Report Stress Induced Acral Lick Dermatitis in a

Case ReportStress Induced Acral Lick Dermatitis in a Domestic Rabbit:A Case Report

Mukesh Srivastava, Anil Ahuja, S. Kachhawaha, N. K Singh,Ankita Sharma, and J. P. Kachhawa

Department of Clinical Veterinary Medicine, CVAS, RAJUVAS, Bikaner, Rajasthan 334001, India

Correspondence should be addressed to Mukesh Srivastava; [email protected]

Received 2 April 2014; Accepted 24 June 2014; Published 9 July 2014

Academic Editor: Paola Roccabianca

Copyright © 2014 Mukesh Srivastava et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

This case report describes acral lick dermatitis in a six-month-old domestic rabbit, which presented with the complaint of excessivelicking of the carpus of left forelimb. Clinical examination showed a single well demarcated, oval, alopecic, ulcerated lesion withperipheral hyperpigmentation and thickening at the carpus of left forelimb. Rabbit was successfully managed with oral fluoxetineand topical application of ointment containing fluocinolone acetonide in 0.025% concentration along with intralesional injectionof hydrocortisone of 0.15mL diluted in normal saline at two sites of a lesion at interval of one week. In addition to medical therapy,hard plastic cat ball, some baby toys, and gnawing sticks were kept with rabbit as a method of environmental enrichment with thepurpose of mental stimulation.

1. Introduction

In some circumstances, an animal may be motivated to per-form two or more patterns of behavior, which are in conflictwith each other like approach-withdrawal, greeting but fearof being punished, and so forth. The inability to performmotivated behavior may lead to stress/frustration and thusdisplacement behavior, which is usually a normal behaviorshown at an inappropriate time, appearing out of contextfor the occasion. Compulsive disorder is usually derivedfrom normal behaviour but appears to be abnormal becauseit is excessive, exceedingly intense, and performed withoutcontext and occurs when animal is repeatedly placed in astate of stress or frustration. Some compulsive behaviour isrepetitive in nature without any obvious goal and function; itis referred to as stereotypy.Most common problems observedin dogs are aggression, house soiling, and unruly behavior[1]. Separation anxiety is probably the most common anxietystate, and underlying anxieties are often seen in conjunctionwith aggression-related problems and compulsive disorders[2]. Canine acral lick dermatitis, canine flank sucking, tailchasing, barbering in laboratory mice, avian psychogenicfeather picking, and feline psychogenic alopecia are common

examples of this disorder in animals [3]. Acral lick dermatitisis excessive, compulsive licking of a focal area on a limb,resulting in a firm, proliferative, ulcerative, alopecic lesion[4]. Lesions are usually single but may be multiple, and theyare most often found on the dorsal aspect of the carpus,metacarpus, tarsus, or metatarsus. The causes of the lickingare multifactorial, but environmental stress (e.g., boredom,confinement, loneliness, and separation anxiety) may beimportant contributor [5]. The most common behavioralproblem in rabbit is aggression, which may be due to poorsocialization, territoriality, inappropriate handling, inade-quate housing, and/or nutritional imbalance [6]. Acral lickdermatitis is well recognized in canine but in rabbit conditionwith similar signs and etiology is not yet described possiblydue to the fact that behaviour displayed by prey species likerabbit is very different from predator species.

2. Case Presentation

A six-month-old rabbit presented to Teaching VeterinaryClinical Complex, CVAS, RAJUVAS, Bikaner, with the com-plaint of excessive licking of the carpus of left forelimb.

Hindawi Publishing CorporationCase Reports in Veterinary MedicineVolume 2014, Article ID 142813, 2 pageshttp://dx.doi.org/10.1155/2014/142813

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Figure 1: Rabbit with the sign of acral lick dermatitis.

History revealed normal feeding, defecation, urination, andseparation of rabbit from his mother as she was sufferingfrom mange. Clinical examination showed a single welldemarcated, oval, alopecic, ulcerated lesion with peripheralhyperpigmentation and thickening at the carpus of leftforelimb (Figure 1). Surface exudate was absent probably dueto continuous licking of lesion. All the vital parameters,behaviour, routine hematology, and skin scrapping exam-inations were unremarkable. On the basis of history andclinical examination the case was diagnosed for acral lickdermatitis due to separation stress. Treatment was initiatedwith fluoxetine at a dose of 1mg/kg daily [7] and topicalapplication of ointment containing fluocinolone acetonide in0.025% concentration. Besides this, intralesional injection ofhydrocortisone was given as 0.15mL diluted in normal salineat two sites of a lesion at interval of one week. Oral syrup ofcefpodoxime at a dose of 7.5mg/kg b.wt. was also given forone week to prevent infection. Along with medical therapy,hard plastic cat ball, some baby toys, and gnawing sticks werekept with rabbit as a method of environmental enrichmentwith the purpose of mental stimulation [8]. After two weeksof therapy appreciable improvement was noticed, in bothappearance of the lesion and licking behavior, after whichrabbit was maintained on topical application of fluocinoloneointment.

3. Discussion

Separation anxiety as a psychogenic factor was recorded as acause of this syndrome, which contributes to the genesis ofa vicious itch-lick cycle [4]. Successful patient managementis dependent upon integrating physiological, social, andenvironmental factors which contribute to the clinical mani-festation of behavioral dermatoses [9]. Besides, boredom furchewingmay also be a sign of insufficient roughage or proteinin the diet. Various abnormal kinds of behavior may be seenin rabbit as a sign of suffering, frustration, fear, or evenboredom [10]; these include bar biting, excessive grooming,and nose sliding [11]. These problems can be improved oralleviated with appropriate environmental enrichment [12].Out of numerous ways of animal environmental enrichment,rabbits tend to be highly motivated tomake use of nutritionalenrichment [10], as they have great need for gnawing wood,

which in seminatural enclosure they satisfy with gnawingroots and branches [13]. Therefore, sticks of soft wood can beused as an effective way to enrich their environment [10].

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

References

[1] G.M. Landsberg, “Distribution of canine behavior cases at threebehavior referral practices,” Veterinary Medicine, vol. 68, pp.1011–1018, 1991.

[2] K. L. Overall, “Fears, anxieties and stereotypies,” in ClinicalBehavioral Medicine for Small Animals, pp. 209–250, Mosby, St.Louis, Mo, USA, 1997.

[3] G. M. Landsberg and D. F. Horwitz, Aggression: Diagnosing andTreating Aggressive Behavior in Dogs and Cats, Custom Care onDisk, Behavior Version, Lifelearn Inc., University of Guelph,MacNabb House, Guelph, Canada, 1998.

[4] L. G. Thelma, J. Peter, and V. K. Affolter, Skin Diseases of theDog and Cat: Clinical and Histopathologic Diagnosis, Wiley-Blackwell, Ames, lowa , USA, 2nd edition, 2005.

[5] S.Mukesh and S. Ashish, “Management of anxiety induced acrallick dermatitis in dogs,” Journal of Canine Development andResearch, vol. 7, pp. 58–60, 2011.

[6] H. I. Robinson and E. A. McBride, “Relationship with otherpets,” in The Waltham Book of Human-Animal Interactions, I.H. Robinson, Ed., pp. 113–125, Pergamon Press, Elmsford, NY,USA, 1995.

[7] D. Wynchank and M. Berk, “Fluxetine treatment of acrallickdermatitis in dogs: a placebo-controlled randomized blindtrial,” Depress Anxiety, vol. 9, pp. 21–22, 1998.

[8] D. Jordan, G. Gorjanc, A. Kermauner, and I. Stuhec, “Thebehaviour of individually housed growing rabbits and the influ-ence of gnawing sticks as environmental enrichment on dailyrhythm of behavioural patterns duration,” Acta AgriculturaeSlovenica, vol. 98, no. 1, pp. 51–61, 2011.

[9] V. Virga, “Behavioral dermatology,” Veterinary Clinics of NorthAmerica—Small Animal Practice, vol. 33, no. 2, pp. 231–251,2003.

[10] V. Baumans, “Environmental enrichment for laboratory rodentsand rabbits: requirements of rodents, rabbits, and research,”ILAR Journal, vol. 46, no. 2, pp. 162–170, 2005.

[11] D. Gunn and D. B. Morton, “Inventory of the behaviour ofNewZealandWhite rabbits in laboratory cages,”AppliedAnimalBehaviour Science, vol. 45, no. 3-4, pp. 277–292, 1995.

[12] Z. Princz, A. Dalle Zotte, I. Radnai et al., “Behaviour of growingrabbits under various housing conditions,” Applied AnimalBehaviour Science, vol. 111, no. 3-4, pp. 342–356, 2008.

[13] M. Stauffacher, “Group housing and enrichment cages forbreeding, fattening and laboratory rabbits,”AnimalWelfare, vol.1, pp. 105–125, 1992.

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