CV

Pyogenic Granuloma

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Pyogenic Granuloma, Epulis Gravidarum, Lobular Capillary Hemangioma

  • Definitions
  1. Pyogenic Granuloma
    1. Highly vascular variant of Capillary Hemangioma
  • Epidemiology
  1. Common lesion in children and young adults
  • Causes
  1. Often idiopathic
  2. Prior Trauma (esp. penetrating injury) or Burn Injury
  3. Viral Infection
  • Symptoms
  1. Bleeding from friable lesion
    1. Occurs with minimal Trauma
    2. Lesions may also ulcerate
  • Signs
  1. Characteristics: Initial
    1. Small bright red, purple to yellow dome-shaped Papule
    2. Grows rapidly into Nodule up to 2 cm in size, over weeks to months
    3. Moist, glistening surface
    4. Often pedunculated, pulpy, friable vascular lesions
    5. Surrounded by Scaling collarette (red, brown or white)
  2. Characteristics: Later
    1. Fibrous lesion similar to fibroma
  3. Distribution
    1. Head and neck (most common in children and young adults)
      1. Eyelid (most common acquired Eyelid lesion)
      2. Gingiva or other mucosal surface
        1. Occurs in infants, children and young adults
        2. Pregnant women (Epulis gravidarum)
          1. Onset in 2% of women in late first trimester, second trimester
          2. Resolves with delivery
    2. Trunk and Extremities (most common in adults)
      1. Finger tips
      2. Lateral nailfold (periungual)
  • Differential Diagnosis
  1. Nodular Melanoma or Amelanotic Melanoma
    1. Elmets (1980) Cutis 25:164-8 [PubMed]
  2. Spitz Nevus
  3. Cherry Angioma
  4. Amelanocytic Nevus
  5. Squamous Cell Skin Cancer
  6. Basal Cell Skin Cancer
  • Management
  • Surgical
  1. Send lesion for pathology due to differential diagnosis
  2. Surgical excision
    1. Lowest recurrence rates if completely excised
  3. Shave excision with electrodesiccation and curretage (or Cryotherapy or laser ablation)
  4. Mean recurrence rate: 4.5% (up to 15%)
    1. Recurs if not completely excised or ablated
  • Management
  • Medical
  1. Consider topical Beta Blockers (e.g. Propranolol, Timolol) under Occlusion in children
    1. Dany (2019) J Drugs Dermatol 18(10):1006-10 +PMID: 31584779 [PubMed]
  • References
  1. Habif (1996) Dermatology, Mosby-Year, p. 732
  2. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
  3. Luba (2003) Am Fam Physician 67(4):729-38 [PubMed]
  4. Plachouri (2019) Int J Dermatol 58(6):642-8 +PMID: 30345507 [PubMed]
  5. Wagner (2024) Am Fam Physician 110(4): 353-61 [PubMed]