Pyogenic Granuloma

Who's At Risk?

Pyogenic granulomas occur in people of all races. Women are more frequently affected by pyogenic granulomas than men, though male and female children are equally affected.

Pyogenic granulomas are most often seen in:

• Children and young adults
• Pregnant women
• Women taking oral contraceptives
• People taking certain oral retinoid medications, including isotretinoin or acitretin (Soriatane®)
• People taking protease inhibitors such as indinavir (Crixivan®)
• People on chemotherapy

Signs & Symptoms

The most common locations for pyogenic granulomas include:

• Lips, gums, and inner mouth (particularly in pregnant women)
• Hands and fingers
• Head and neck
• Feet and toes
• Upper trunk

Typically, pyogenic granulomas appear as a beefy, red bump that enlarges rapidly over a few weeks. On average, pyogenic granulomas are about 5–10 mm in diameter. They may bleed easily and, in some cases, can be tender. Very rarely, more than one lesion of pyogenic granuloma may develop at the same time at the same site.

Self-Care Guidelines

See your doctor if you notice any rapidly enlarging skin growth in order to establish a correct diagnosis. Because it is prone to easy bleeding, a pyogenic granuloma lesion should be covered with a bandage until you see your doctor.

Treatments

If the diagnosis of pyogenic granuloma is suspected, your doctor will probably want to perform a skin biopsy. The procedure involves:

1. Numbing the skin with an injectable anesthetic.
2. Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a “punch biopsy”). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6–14 days later.
3. Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).

Pyogenic granulomas that develop in pregnant women often resolve after delivery. Similarly, pyogenic granulomas associated with medications usually improve when the medicine is discontinued or the dosage is lowered. Depending on the size of the pyogenic granuloma and its location and symptoms, the doctor may decide that no treatment is necessary for pregnant women or for people who can safely stop or lower the dose of the medication that caused the lesion.

Although pyogenic granuloma is a benign condition, it is frequently removed due to its tendency to bleed, its tenderness, and its distressing appearance. However, untreated pyogenic granulomas may go away on their own.

In obvious cases of pyogenic granuloma, your physician may choose to treat it immediately after obtaining the biopsy. Such treatments include:

• Scraping and burning (curettage and cauterization). After numbing with local anesthetic, the area is scraped with a sharp instrument (a curette) and burned with an electric needle (cautery).
• Silver nitrate solution
• Topical imiquimod cream (Aldara®)
• Laser treatment
• Freezing with liquid nitrogen (cryotherapy)
• Surgical removal (excision)

Approximately 40% of pyogenic granulomas come back (recur) after treatment, especially those lesions located on the trunk of teenagers and young adults. Recurrent pyogenic granulomas are best treated by surgical excision.

Visit Urgency

Make an appointment with a dermatologist or another physician if any rapidly enlarging or bleeding growth develops on your skin or in the areas lining your nose or mouth (mucous membranes).

Trusted Links

• MedlinePlus: Benign Tumors
• MedlinePlus: Skin Conditions
• Clinical Information and Differential Diagnosis of Granuloma, Pyogenic

References

Bolognia, Jean L., ed. Dermatology, pp.1823-1824. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed, pp.1003, 1009. New York: McGraw-Hill, 2003.