Overview

Pyogenic granuloma, also known as lobular capillary hemangioma, is a common benign (non-cancerous) growth of the skin and mucous membranes. It presents as a small, reddish, rapidly growing bump that tends to bleed easily. Despite the name, pyogenic granuloma is neither infectious (pyogenic means pus-producing) nor a true granuloma. These lesions are often triggered by minor trauma, hormonal changes, or certain medications, and they frequently occur on the hands, face, and inside the mouth. While harmless, pyogenic granulomas can cause discomfort and cosmetic concerns due to their tendency to bleed and grow quickly.

Causes

The exact cause of pyogenic granuloma is not completely understood, but several contributing factors have been identified:

• Trauma or injury: Even minor cuts, scratches, or repeated irritation can lead to the development of pyogenic granuloma at the site of injury.
• Hormonal changes: Common in pregnant women, especially in the gums, due to hormonal fluctuations, a condition sometimes called "pregnancy tumor."
• Medications: Certain drugs, including oral contraceptives, retinoids, and some chemotherapy agents, have been associated with pyogenic granuloma.
• Skin irritation: Chronic irritation from jewelry, piercings, or dental appliances can lead to localized lesions.
• Idiopathic cases: In some individuals, no obvious cause is identified.

Symptoms

Pyogenic granuloma typically presents with distinct features that make it recognizable:

• Appearance: Small, round, or lobulated bump, bright red or purple in color, often shiny or moist-looking.
• Rapid growth: Lesions can grow quickly over a few days or weeks to a size of a few millimeters to 2 centimeters.
• Bleeding: The bump bleeds easily, even with minor trauma or touch, due to its rich blood supply.
• Location: Commonly found on the fingers, hands, arms, face, neck, and gums (especially during pregnancy).
• Pain or discomfort: Generally painless but may cause discomfort or tenderness if irritated.
• No systemic symptoms: Pyogenic granuloma is a localized skin condition and does not cause fever, malaise, or systemic illness.

Diagnosis

Diagnosis of pyogenic granuloma is primarily clinical, based on the characteristic appearance and history of rapid growth. Diagnostic steps include:

• Physical examination: Healthcare providers can usually identify the lesion by examining its size, shape, and bleeding tendency.
• Dermatoscopy: A dermatoscope may be used to examine the lesion's vascular structure more closely.
• Biopsy: In uncertain cases or if malignancy is suspected, a skin biopsy may be performed to confirm the diagnosis and rule out skin cancer, such as amelanotic melanoma or squamous cell carcinoma.

Pyogenic granuloma is generally easy to diagnose, but healthcare providers must rule out other skin lesions that may appear similar.

Treatment

Although pyogenic granuloma is benign, treatment is often sought due to cosmetic concerns, recurrent bleeding, or rapid growth. Treatment options include:

• Observation: In some cases, especially during pregnancy, the lesion may regress spontaneously after hormonal levels normalize.
• Topical treatments: Application of topical beta-blockers like timolol may be helpful in certain cases, particularly in children.
• Cryotherapy: Freezing the lesion with liquid nitrogen, commonly used for smaller lesions.
• Surgical excision: Complete surgical removal of the lesion under local anesthesia, often followed by electrocautery to minimize bleeding and reduce recurrence.
• Laser therapy: Pulsed dye laser or CO2 laser can effectively remove pyogenic granulomas with minimal scarring.
• Curettage and cauterization: Scraping off the lesion followed by cauterization of the base to stop bleeding.
• Treating underlying causes: Managing contributing factors such as irritation or discontinuing causative medications if applicable.

Prognosis

The prognosis for pyogenic granuloma is excellent, as it is a benign lesion with no risk of malignancy. However, certain considerations include:

• High recurrence rate: Recurrence can occur, particularly if the lesion is not completely removed or if contributing factors persist.
• Scarring: Some treatment methods, especially surgical removal, may leave a small scar.
• Resolution after pregnancy: Pyogenic granulomas related to pregnancy often regress spontaneously after childbirth.
• No serious complications: Pyogenic granulomas do not spread or lead to systemic health issues but can be a nuisance due to bleeding.

With appropriate treatment, most individuals experience complete resolution of pyogenic granulomas, and cosmetic outcomes are generally favorable, especially with early management.