Pyogenic Granuloma

Who's At Risk?

Pyogenic granulomas are unlikely to occur in infants. Pregnant women and people who have weak immune systems are most often affected.

Signs & Symptoms

The most common locations for a pyogenic granuloma include:

• Hands, fingers, and forearms
• Head, face, and neck
• Lips, gums, and inner mouth (particularly in pregnant women)
• Trunk

Usually, a pyogenic granuloma appears as a beefy, red bump that enlarges rapidly over a few weeks. On average, a pyogenic granuloma is 5–10 mm in diameter. It is likely to bleed easily, and, in some cases, can be tender to the touch. Rarely, multiple lesions of pyogenic granuloma may develop at the same time (simultaneously) at the same location.

Self-Care Guidelines

Any rapidly growing skin growth should be examined by a physician in order to confirm the correct diagnosis. Because a pyogenic granuloma may bleed easily, cover the lesion(s) with a bandage until you see your child’s doctor.

Treatments

If the diagnosis of pyogenic granuloma is suspected, the doctor may 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 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 go away after delivery. Similarly, pyogenic granulomas associated with medications usually shrink (regress) when the medicine is stopped or the dosage is lowered. Depending on the pyogenic granuloma’s size, 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 triggering medication.

Although pyogenic granuloma is a non-cancerous (benign) condition, it is frequently removed due to its tendency to bleed, its tenderness to touch, and its distressing appearance. However, a pyogenic granuloma may go away on its own without treatment.

If the pyogenic granuloma is obvious, the physician may choose to treat it immediately after obtaining a 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 after treatment, especially those lesions located on the trunk of teenagers and young adults. A pyogenic granuloma that comes back (recurs) is best treated by surgical removal (excision).

Visit Urgency

Make an appointment with your child’s doctor or a dermatologist if any rapidly growing or bleeding growth develops on your child’s skin or in the areas lining body cavities (mucous membranes) such as the mouth, nose, ears, eyes, or genitalia.

Trusted Links

• 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.