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.
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. It is GLUT-1 negative. The "bandage sign" is the frequent observation of patients presenting with bandages covering the lesion, as they bleed easily and are often covered to prevent trauma and bleeding.
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.
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.
Salt treatment is a safe and effective way to treat pyogenic granulomas. The treatment involves:
Salt is believed to act as a desiccant, causing shrinkage of the small vessels feeding the PG. The treatment is minimally painful, with a mild sensation of stinging during application.
In the largest case series to date, salt led to the resolution of PGs within approximately 2 weeks. 100% of the cases showed complete resolution of the lesion without any residual scar, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response.
Even in cases without complete resolution of the lesion, it helps reducing the size of the PG prior to other interventions. The patient should be told that if the lesion has not gone (or almost gone) within two weeks of starting the salt treatment, to contact your.
One, two, or three treatments with the pulsed dye laser was successful in 91% of children in one series.
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