Pyogenic granuloma

What is pyogenic granuloma?

Pyogenic granuloma is a relatively common, reactive proliferation of capillary blood vessels. It presents as a shiny red lump with a raspberry-like or minced meat-like surface. Although they are benign, pyogenic granulomas can cause discomfort and profuse bleeding.

Pyogenic granuloma is also called lobular capillary haemangioma, granuloma pyogenicum and granuloma telangiectaticum.

Pyogenic granuloma

Pyogenic granuloma

Pyogenic granuloma

New lesion

2 weeks later

4 weeks after first photograph

What causes pyogenic granuloma?

The cause of pyogenic granuloma is unknown. The following factors have been identified as having a possible role in their development.

• Trauma: some cases develop at the site of a recent minor injury, such as a pinprick.
• Infection: Staphylococcus aureus is frequently present in the lesion.
• Hormonal influences: they occur in up to 5% of pregnancies and are sometimes associated with an oral contraceptive.
• Drug-induced; multiple lesions sometimes develop in patients on an oral retinoid (acitretin or isotretinoin) or a protease inhibitor.
• Viral infection is possible but not proven.

Who gets pyogenic granuloma?

Pyogenic granuloma affects people of all races. Women are affected more often than men because of the relationship with pregnancy. It rarely occurs in children less than 6 months old but is common in children and young adults.

What are the signs and symptoms of pyogenic granuloma?

Pyogenic granuloma usually first appears as a painless red, brownish-red or blue-black spot. It grows rapidly over a period of a few days to weeks to a final size of 1–2 cm (rarely up to 5 cm). It typically bleeds easily and may ulcerate to form a crusted sore. Usually a single lesion is present but in rare cases multiple lesions may develop.

They are most frequently found on the head, neck, upper trunk, hands (especially fingers) and feet. The pregnancy variant of pyogenic granuloma most often occurs on the mucosal surfaces of the lip or inside the mouth.

How is pyogenic granuloma diagnosed?

Pyogenic granuloma is usually diagnosed clinically because of its typical time course and appearance.

Histology confirms the diagnosis, especially if a form of skin cancer such as amelanotic melanoma is in the differential diagnosis. Pyogenic granuloma reveals a lobular collection of blood vessels within inflamed tissue.

What treatment is available for pyogenic granuloma?

Pyogenic granulomas may go away on their own, particularly those associated with pregnancy. If due to a drug, they usually disappear when the drug is stopped.

There are several methods used to remove pyogenic granuloma.

• Surgical excision
• Curettage and cauterisation: the lesion is scraped off with a curette and the feeding blood vessel cauterised to reduce the chances of re-growth.
• Laser surgery can be used to remove the lesion and burn the base, or a pulse dye laser may be used to shrink small lesions.
• Cryotherapy may be suitable for small lesions.
• Chemical cauterisation using silver nitrate is effective for small lesions.
• Imiquimod cream has been reported to be effective and may be particularly useful in children.
• Experimentally, topical 1% propranolol ointment has proved effective when used early in children with pyogenic granuloma [1].

Recurrence after treatment is common because feeding blood vessels extend deep into the dermis in a cone-like manner. In these cases, the most effective method of removal is to completely cut out the affected area (excision), which is then closed with stitches.