Q. My dog keeps getting these wounds on her front legs. Last year it was up above her wrist and this year it’s closer to her toes. I’ve tried everything the vets have recommended and it keeps coming back every few months. I’m at my wits’ end.

I don’t blame you. This condition is on my Top 10 list of most frustrating afflictions to treat.

Acral lick dermatitis, also known as an acral lick granuloma, is a skin condition in dogs caused by excessive licking in one or more spots, usually on the front of the forelimbs, as you’ve described.

Dogs will lick one or more areas incessantly, which leads to hair loss, open sores and infection — which leads to even more licking. It’s thought that this cycle of self-trauma is also perpetuated by the release of endorphins when dogs lick these areas.

Though this is skin condition, the fact that most of these dogs seem to suffer from a compulsion to lick leads us to classify it as a behavioral disorder as well. In fact, more than 50 percent of dogs with acral lick dermatitis also suffer from fear- or anxiety-based conditions as well (e.g., separation anxiety, thunderstorm phobia, fear aggression).

Underlying allergies or arthritis pain, among other issues, may also be associated with it.

What’s a devoted dog owner to do?

Veterinary dermatologists tend to opt for treating the infection with antibiotics. Corticosteroids may also be recommended.

Behaviorists tend to focus on behavior modification, and sometimes employing drugs that have been shown to help dogs with fear, anxiety, and/or obsessive/compulsive disorders.

But all veterinarians tend to focus first on deterrence — special collars, bandages, and/or muzzles. Such measures are typically employed for a only short period of time, until other measures take effect.

Laser therapy and other less common alternatives are sometimes also offered.

Dr. Patty Khuly has a veterinary practice in South Miami and blogs at www.dolittler.com. Send questions to khulyp@bellsouth.net, or Dr. Dolittler, Tropical Life, The Miami Herald, 1 Herald Plaza, Miami, FL 33132.