Pyogenic granuloma

Pyogenic granuloma 1

Pyogenic granuloma (Lobular capillary hemangioma) is a benign post-traumatic proliferation of capillary blood vessels. ICD-10 code: L98.0

It can occur at any age but is more common between 10-40 years old and is not significantly affected by ethnicity. It is slightly more common in females, especially when localized in the oral cavity.

The etiology and pathogenesis are not completely understood. The role of certain viruses (papillomaviruses, herpes viruses), microtrauma (microinjuries), hormonal imbalances (more common in pregnant women and during menopause), medications (anticancer drugs, antiretroviral drugs, retinoids, immunosuppressants, oral contraceptives, epidermal growth factor receptor inhibitors) are being considered. In recent times, importance is attached to sporadic mutations in the BRAF gene (v-Raf murine sarcoma viral oncogene homolog B1 - a gene encoding proteins that regulate cell growth signaling pathways).

Typical pyogenic granuloma

Pyogenic granuloma 2

Presents as a single papule up to 1 cm in diameter with a shiny surface, firm elastic consistency, and variable color ranging from light gray to dark red. It is characterized by rapid growth (within a few weeks) followed by stabilization, The lesion may acquire a lobulated, mushroom-like, or perpendicular shape. The condition usually progresses without subjective sensation, but the growth may bleed easily upon trauma, often resulting in erosions and ulcers covered with crusts. The eroded surface often has a "granular" appearance. The presence of a rim around the lesion is characteristic when located on the palms and soles, where they are often traumatized.

The eruptions can occur anywhere, but they are most commonly found on the dorsum of the hands, feet, and fingers due to their frequent trauma.

Oral pyogenic granuloma

Oral pyogenic granuloma
Characterized by polypoid pink-red color papule, ranging in size from 0.5-6 cm with a tendency to frequent bleeding, erosion and ulceration. It most commonly affects the gums and occasionally the mucosa of the lips, tongue, cheeks, and palate. Patients often report changes in taste and a burning sensation.

Giant pyogenic granuloma

Giant pyogenic granuloma
A tumor larger than 3 cm in diameter is considered giant, although it can sometimes reach 12-15 cm. This form is rare.

Ocular pyogenic granuloma

Pyogenic granuloma eye
Characterized by appearance of typical papules and nodules in the area of the eyelids and conjunctiva. Patients often complain of lacrimation, photophobia, and foreign body sensation.

Genital pyogenic granuloma

Genital pyogenic granuloma
A rare form of pyogenic granuloma of vulva, penis, and occasionally scrotum. Predisposing factor in men is trauma due to circumcision. In addition to the typical clinical presentation when located on the penis, in some cases an increase in tumor size during erection may be observed.

Subungual pyogenic granuloma

Subungual pyogenic granuloma
Presents as a typical papule or nodule located in the subungual space. It is characterized by marked pain and discomfort. Common features include onycholysis, leukonychia, and subungual hemorrhage.

Multiple pyogenic granuloma

Multiple pyogenic granuloma
Very rare form of pyogenic granuloma. It is characterized by multiple eruptions of typical elements, arranged both in groups and scattered. Scalp is a common site of this form.

The diagnosis is made based on the characteristic clinical presentation, dermoscopy, and histological examination.

  • Kaposi Sarcoma
  • Hemangioma
  • Amelanotic melanoma
  • Bacillary angiomatosis
  • Cherry Angioma
  • Verrucous squamous cell carcinoma
  • Metastases
  • Glomus Tumor
  • Angiosarcoma
  • Nevus Spitz
  • Angioleiomyosarcoma
  • Clear Cell Acanthoma
  • Peripheral Giant Cell Granuloma
  • Acrochordon (Skin tag)
  • Odontogenic Fibroma
  • Juvenile Xanthogranuloma
  • Spider Angioma
  • Ossifying Fibroma
juvenile xanthogranuloma dd tab 1

  • Surgical excision and cryotherapy
  • Curettage
  • Sclerosing therapy
  • Laser therapy (ND-YAG, CO2, diode with wavelengths of 808-980 nm)
  • Topical non-selective beta-adrenergic blockers (1% propranolol cream, 0.5% timolol solution in form of drops or gel).