PYOGENIC GRANULOMA

By Gary M. White, MD

Pyogenic Granuloma


A pyogenic granuloma (PG) is a vascular growth common in both children and pregnant women. It seems to represent a reactive and hyperplastic condition, rather than a neoplasm. It usually develops at the site of skin injury and frequently bleeds.

Clinical

The sudden appearance of a vascular, friable papule that bleeds easily on the finger, palm, sole, head, or neck is characteristic of a pyogenic granuloma. It is more common in pregnancy and in those patients on isotretinoin, especially in the periungual areas. Topical retinoid use has also induced PG. It may rarely occur after cryosurgery. It may occur in the periungual area, especially in the setting of retinoid or indinavir administration.

Multiple lesions may occur after burns [Pediatric Dermatology Vol. 32 No. 4 e175–e176, 2015] or lightning strike.

Is HPV-2 casually related? See above.

Satellitosis

Multiple pyogenic granulomas may occur within or at the periphery of the scar of the treated primary lesion 1 to 4 weeks after its treatment. Lesions are often located on the back, especially the scapular region [Ped Derm 2016;33;97].

Treatment

Local anesthesia followed by shave biopsy, curettage, and electrocautery is usually curative. If the lesion is not fully curetted, control of bleeding may be difficult and recurrence common. For lesions on a digit, a tourniquet may help during the procedure.

Aftercare should be minimal, allowing the area to scab. Patients and/or parents should always be told of the small risk of recurrence. If recurrence does occur, the same procedure may be tried again, or elliptical excision including a small amount of dermis may be done. The eruption of multiple lesions after treatment of a single one (satellitosis) occurs rarely.  In the case of a giant PG with satellitosis, an oral steroid was successfully employed.

One, two, or three treatments with the pulsed dye laser was successful in 91% of children in one series.

Timolol

Topical timolol, gel forming solution 2-3 times a day has been used with moderate success after 4-6 months of use. Pediatr Dermatol. 2014 Mar-Apr;31(2):203-7. It may be considered in recurrent PG, satellitosis, and PGs in areas where surgical intervention is difficult.

Miscellaneous

Topical imiquimod nightly has had some success. Clobetasol under occlusion can be helpful.

Additional Pictures

Hidden underneath the crust in the scalp of a child.
Pyogenic Granuloma covered with Crust Pyogenic Granuloma

PG in a pregnant woman.
Pyogenic Granuloma

The hands and feet are typical areas.
Pyogenic Granuloma Pyogenic Granuloma of the finger Pyogenic Granuloma of the nail bed

A patient on isotretinoin with a staph paronychia and a pyogenic granuloma.
Pyogenic Granuloma, paronychia and an ingrown nail

Pyogenic granuloma x 2 in a patient on isotretinoin.
Pyogenic Granuloma in a patient on isotretinoin

Pyogenic granuloma in a woman who constantly bit her nails (onychophagia)
Pyogenic Granuloma in a woman who bit her nails

References

Satellitosis after shave biopsy of primary lesion. Actas Dermo-Sifiliograficas 103;06;July 2012 - August 2012

Multiple PGs after a single PG was treated with pulsed-dye laser. Cutis. 2014 April;93(4):E4-E6

Eruptive disseminated PG after lightning strikes. Dermatology 2015;230:199–203

Multiple PGs after a burn. Pediatric Dermatology Vol. 32 No. 4 e175–e176, 2015

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