Publish date: Posted on
Last updated: May 16, 2022
Keywords #
pyogenic granuloma
PG
lobular capillary hemangioma
LCH
granuloma pyogenicum
Diagnosis #
Pyogenic granulomas, sometimes referred to as lobular capillary hemangiomas are painless, benign, vascular proliferations that may appear on the skin or mucosal surfaces. Pyogenic granulomas may be susceptible to trauma, become ulcerated or bleed profusely.
Key Concepts #
- Pyogenic granulomas are friable, red, pedunculated papules that often ulcerate and are prone to recurrence.
- Despite their name, pyogenic granulomas are not associated with any kind of infectious etiology, fungal or bacterial.
- Pyogenic granulomas may mimic other cutaneous malignancies.
Epidemiology #
Most pyogenic granulomas arise in the second decade of life. Males are more likely to experience pyogenic granulomas in cutaneous locations whereas females are more likely to develop them in mucosal sites. [2] Mucosal lesions are very common in pregnancy and are likely due to hormonal influences. [3] The mean age of onset in children is 6 years of age. [4]
Clinical Features #
- Pyogenic granuloma appears as a solitary, friable, red/purple papule that grows rapidly over weeks to months.
- Common sites include trunk, head, neck, gingiva, cheek, and lips.
- Pyogenic granulomas may be congenital, triggered by certain medications, pregnancy, trauma, or hormonal fluctuations. However, most cases are idiopathic.
Differential Diagnoses #
- Thrombosed hemangioma/angiokeratoma
- Basal cell carcinoma
- Infantile Hemangioma
- Glomus tumor
- Angiosarcoma
- Bacillary angiomatosis
- Kaposi sarcoma
Diagnostic Workup #
The diagnosis of pyogenic granuloma is usually clinical and based on history and physical exam. However, given pyogenic granuloma’s tendency to mimic malignancies such as Kaposi sarcoma and basal cell carcinoma, biopsies are often used to exclude malignancies. The most common dermoscopic findings found in pyogenic granulomas are red structureless areas, intersecting thick white lines, ulceration, and numerous, lobular capillary proliferations. [5]
Treatment #
Although treatment is usually recommended to avoid excessive ulceration and bleeding, there is no agreement as to which method is best. Treatment is usually aimed at removing the entire lesion and avoiding recurrence. Whatever technique is used it is recommended that a biopsy is sent for histopathological testing. Surgical excision is a good option for surgically accessible areas and adults who can tolerate the procedure. It is also associated with a lower recurrence rate than other methods. [3] Other options include cryotherapy, punch biopsy, curettage, shave excision, pulsed dye laser/CO2 laser, or cautery. Topical therapies exist but are generally not recommended due to high recurrence rate and the inability to send a specimen for histologic examination.
References #
- Mills, S E et al. “Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral andnasal mucous membranes.” The American journal of surgical pathologyvol. 4,5 (1980): 470-9
- Harris, M N et al. “Lobular capillary hemangiomas: An epidemiologic report, with emphasis on cutaneous lesions.” Journal of the American Academy of Dermatologyvol. 42,6 (2000): 1012-6.
- Giblin, A V et al. “Pyogenic granuloma -the quest for optimum treatment: audit of treatment of 408 cases.” Journal of plastic, reconstructive & aesthetic surgery : JPRASvol. 60,9 (2007): 1030-5.
- Pagliai, Kelley A, and BernardA Cohen. “Pyogenic granuloma in children.” Pediatric dermatologyvol. 21,1 (2004): 10-3.
- Elmas, Ömer Faruk et al. “Pyogenic granuloma and nodular Kaposi’s sarcoma: dermoscopic clues for the differential diagnosis.” Turkish journal of medical sciencesvol. 49,5 1471-1478.
