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Dogs that lick enough will develop inflammation of the skin (dermatitis) in the overgroomed areas.
Over time, the self-trauma inflicted by affected dogs progresses beyond dermatitis into a condition known as granuloma. Acral lick dermatitis, like most behavioral or psychogenic issues, is very difficult to treat, and consequently very frustrating for the owners of affected dogs.
However, my dog also licks and bites at his feet, tail, legs and stomach area if he’s itchy.
The tingling and itching inspire further licking, which exacerbates the dermatitis, and an unfortunate feedback cycle develops.

Allergies to fleas, food, and environmental agents should be explored and ruled out or treated as appropriate in any dog with the syndrome. Worse still, in severe cases the licking is believed to release endorphins (natural brain chemicals that feel good).
Granulomas can be severe — I have met dogs whose entire legs consisted of skin that was nothing but granuloma.
Dogs that are worn out from long walks or nice fetch sessions may be too tired and content to overgroom. Fluoxetine (known as Reconcile when dogs take it and Prozac when people take it) and clomipramine (Clomicalm) are antidepressants, which may reduce the urge to overgroom.

However, if my dog were faced with the choice of taking Prozac or wearing an E-collar continuously, I know which one he (and I) would prefer. Predisposed dogs may overgroom in response to boredom, or excessive licking may be linked to stress or anxiety.
For some dogs it is a food allergy and you will need to try different foods to try and eliminate it.

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