Pyogenic granuloma


Pyogenic granuloma

Description, Causes and Risk Factors:

Pyogenic granulomata are common benign vascular lesions of the skin and mucosa. They are neither infective, purulent, or granulomatous as the name might suggest - rather a reactive inflammatory mass of blood vessels and a few fibroblasts within the dermis of the skin. Mean age for presentation is 6-7 years old. Thereafter, decrease in incidence with age. They represent 0.5% of skin nodules in children. More common in women due to frequent formation on the gingiva during pregnancy (pregnancy tumor or epulis gravidarum) - occur in up to 5% pregnancies.

The disease is not fully understood: rapid growth occurs in response to an unknown stimulus that triggers endothelial proliferation and angiogenesis. Trauma and burns can provoke the sequence but frequently there is no identifiable cause.

Other suggested causes include viral oncogenes, hormonal influences (pregnancy, oral contraceptive pill) and cytogenetic abnormalities. They have also been associated with certain medications.

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.

Frequent bleeding is the most common type of complication. Pyogenic granulomas can also grow back after being removed. The American Osteopathic College of Dermatology states that this happens in up to half of all cases, especially in young adults with pyogenic granulomas in the upper back area. (AOCD) In rare cases, several lesions can appear in the area where the pyogenic granuloma was removed. If the granuloma was not removed completely, the remaining parts can spread to your blood vessels in the same area.

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.

Diagnosis:

Your doctor might be able to diagnose a pyogenic granuloma based on its appearance. Your doctor might do a biopsy, which involves taking a tissue sample, for a more accurate diagnosis. A biopsy also helps rule out malignant, or cancerous, medical conditions that can cause this kind of growth, such as squamous cell carcinoma, basal cell carcinoma, and melanoma.

Treatment:

A conservative approach is an appropriate option, because most untreated recurrent lesions disappear spontaneously in 6 to 12 months. When treatment is prescribed, the same methods as those of simple pyogenic granuloma are used. The treatments include Nd:YAG laser, topical imiquimod, and intralesional bleomycin, in addition to systemic corticosteroids for giant lesions in the proliferative phase.

Large pyogenic granulomas: If you have a bigger growth, your doctor will most likely scrape it off and lightly cauterize or burn it. Cauterizing helps stop bleeding and can reduce the risk of having it grow back

The most effective way to remove pyogenic granulomas involves surgically removing the entire growth and using stitches to close the wound. (AOCD) This is a more invasive procedure than scraping one off.

Alternatively, your doctor might apply a chemical, such as silver nitrate, to the pyogenic granuloma to help with the bleeding. These growths can also be removed using laser surgery.

Pyogenic Granulomas on the Eye: Pyogenic granulomas that grow on your eye can be surgically removed or treated with ointments containing corticosteroids, which help reduce inflammation.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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