Pyogenic Granuloma

What is a pyogenic granuloma?

A pyogenic granuloma is due to a rapid growth of blood vessels in the surface of the skin. They usually develop as small cherry-red skin lesions that have a raw-meat appearance. The bleeding may be profuse and the lesions can occasionally be tender. They frequently occur in young adults and in women. They are more common in pregnancy.

Pictures

 

Peduncluated pyogenic granuloma
Pyogenic granuloma close-up
 

 

Pyogenic granuloma finger

Pyogenic granuloma thumb

 

What causes pyogenic granuloma?

The cause of pyogenic granuloma is not precisely known. Several factors are known to promote the growth of vessels in the skin and these include trauma (gardening or thorn injuires), hormonal influences (vessel growth is more common in pregnancy probably due to oestrogen), infection (staphylococcal aureus bacterial infection) and rarely drugs (patients taking systemic retinoids rarely develop multiple pyogenic granuloma type lesions).

Is treatment necessary?

Pyogenic granulomas may resolve without treatment and this is especially common in pregnancy after delivery of the baby. They may also resolve in children. In older patients >40 years, a sample should always be sent off for histology to exclude a serious type of skin cancer called an amelanotic melanoma. This may resemble a bleeding pyogenic granuloma and can grow very rapidly.

Melanoma resembling a pyogenic granuloma

Pyogenic granuloma after curettage

  Treatment Options

Pyogenic granuloma may be removed by scraping them off the skin surface. This normally requires a small anaesthetic injection into the skin and the base of the lesion is then cauterised to stop it bleeding. A scar may develop at the base due to the cauterisation as the blood vessels are often located deeply in the skin. Rarely, the base needs to be surgically removed by cutting it out.

A silver nitrate stick may be used to stop a pyogenic granuloma from bleeding. This can be successful at treating small pyogenic granuloma but is rarely useful for larger lesions.

Freezing with liquid nitrogen may be used to treat small pyogenic granuloma. This treatment is frequently used by doctors for many types of skin lesions. Light freezing usually causes no permanent damage to the skin, however, cryotherapy may cause loss in skin colour (hypopigmentation), darkening (hyperpigmentation), and rarely scarring.