Last reviewed by Editorial Team on August 13th, 2018.
What is Pyogenic Granuloma?
Pyogenic granuloma is a common and benign vascular lesion that usually develops on the mucosa and the skin. The disease is characterized by the rapid growth of the vascular lesion which appears as a tissue overgrowth. It has the tendency to bleed profusely as the vascular lesion is composed of numerous blood vessels. Pyogenic granuloma also does not resolve spontaneously.
Pyogenic granuloma is also known by another name such as lobular capillary hemangioma, eruptive hemangioma and pregnancy tumor. The term pyogenic granuloma on the other hand is a misnomer since the disease is not a true granuloma and is neither pus forming and infectious. Pyogenic granuloma is common in and around the mouth but can also occur in the fingers, hands and feet including the nasal septum and gums and with less frequency in the trunk and other areas of the body. The lesion can also occur in the conjunctiva or the cornea of the eye although this seldom happens. It is generally a harmless condition but can cause pain and irritation.
Pyogenic granuloma is common in children but seldom in children below 6 months of age. It occurs at any age but seldom in older adults and the peak age of onset is usually during the second decade of life. Pyogenic granuloma affects both men and women although there is a slight prevalence among women probably due to the incidence of gingival during the process of pregnancy. The disease of pyogenic granuloma is not associated with morbidity as it is basically harmless except it can cause discomfort and pain and has the tendency to bleed profusely. The growth of lesion however may also develop in another area of the body distant from the original lesion and after the original lesion has been removed.
Pyogenic granuloma is also referred to as granuloma gravidarum when it is present during pregnancy. In general, pyogenic granuloma develops in the area of the skin with previous trauma. Pyogenic granuloma is basically benign but the disease can be cancerous. A biopsy is rather important to determine the real characteristic of the lesion and isolate pyogenic granuloma. Cancer can mimic that of pyogenic granuloma although this seldom happens yet a biopsy is significant.
Symptoms of Pyogenic Granuloma
Pyogenic granuloma is a benign vascular lesion that commonly develops in the skin and the mucosa. It is a harmless disease although it can cause significant pain and discomfort and often bleeds profusely. The lesion is composed of numerous blood vessels which explain the profuse bleeding.
Pyogenic granuloma lesion often occurs as solitary and the onset is rather rapid. The lesion is characterized by the following:
- The lesion can develop in any part of the body although more common in the face, mouth, fingers, arms and neck
- The lesion may also occur in the gums, particularly in pregnant women, thus, the term granuloma gravidarum or pregnancy tumor
- The color of the lesion is often bright red although it may also be in purple, pink or yellow color
- The size of the lesion varies but the average size is approximately 6.5 mm in diameter but can grow as large as 25 cm in diameter
- The lesion is similar to the appearance of a raspberry or like a raw meat of ground beef
- The surface of the lesion is initially smooth and moist
- The lesion will later have bleeding, ulceration and crusting
- The lesion in the scalp may secrete an oily substance which makes the affected area damp at times
- Multiple smaller pyogenic granulomas termed as satellites often form as a recurrence after the primary lesion has been treated
The exact cause of pyogenic granuloma remains unclear with the development of the lesion often noticed after an injury and is mistaken for a scab or a poorly healed wound. The exact mechanism of pyogenic granuloma remains unknown but there are several factors being considered to play a role in the development of the lesion.
- Trauma is mostly implicated in the development of the lesion in pyogenic granuloma. The lesion generally occurs at the site of recent injury which may be as minor as a simple cut or a prick of a needle where the wound did not heal appropriately.
- Infection is also another factor that contributes to the development of pyogenic granuloma. Mostly implicated is infection from Staphylococcus aureus which is often found to be present in the lesion.
- Hormonal change is one of the most implicated in the cause of pyogenic granuloma which is evident in pregnant women. It is rarely seen however, in oral contraceptive use.
- Medication can also induce the onset of pyogenic granuloma. Certain medications such as that use of acne treatment are believed to trigger the development of the lesion. Other medications believed to induce pyogenic granuloma include Indinavir, systemic retinoid and that used for chemotherapy such as Paclitaxex and Fluorouracil.
- Viral infection is considered to play a role in the incidence of pyogenic granuloma. The relation of pyogenic granuloma with viral infection on the other hand has no clear proof.
- Cytogenic abnormality or blood vessel malformation is considered to influence the onset of pyogenic granuloma.
Pyogenic granuloma has no specific treatment. Small lesions usually heal spontaneously whereas in pregnancy, the lesion also resolves spontaneously after delivery. Pyogenic granuloma related to medication may need not be treated as well as the lesion usually goes away when the medication ceased to be taken.
Removal of the lesion is the best way to treat pyogenic granuloma. This method of treatment is especially indicated for large size lesion which is often irritated and often bleeds. There are several methods that can be done to remove the lesion of pyogenic granuloma which is an option for cosmetic concern and according to the preference of the patient.
- Curettage and cauterization are one way of scraping off of the lesion with the use of a specialized instrument called a curette. The blood vessel is then cauterized to lessen the chances of recurrence or.
- Laser therapy is another method of removing the lesion by burning the base of the lesion.
- Cryotherapy is one way of scraping off of the lesion with the use of liquid nitrogen to freeze the lesion. The lesion will later fall off after it has been frozen with liquid nitrogen. This method however is best indicated for small size lesion.