Pyogenic Granuloma: Lobular Capillary Hemangioma…

Pyogenic granuloma (PG) is a relatively common small, eruptive, usually solitary sessile or pedunculated, often friable papule.  Another description is they present as a shiny raspberry-like or “minced meat” surface (see pictures below) papule.  It is also referred to as a lobular capillary hemangioma and granuloma telangiectaticum.  PGs bleed easily on the slightest of trauma and if cut off superficially will promptly recur.

They are most often related to trauma, although infections, hormonal influences (up to 5% of all pregnancies), and certain medications such as oral retinoids (acitretin & isotretinoin) and protease inhibitors.  The most common areas involved include exposed areas, such as the hands, forearms, or face.  It commonly is found to involve the mouth, especially the gingiva, most often in pregnant women.  On the soles of the feet or along the nail bed it may be mistaken as a melanoma.

TREATMENT:  I usually treat these by biopsy removal.  The tissue is always sent to pathology to confirm the diganosis.  There is often a deeper vessel, I call it a feeder vessel, that needs to be vigorously cauterized.  If this vessel is not treated adequately the PG will grow back…and grow back quickly.  Other treatment options include curettage, topical timolol or imiquimod under occlusion, topical propranolol 1% ointment and sclerotherapy with monoethanolamine oleate or sodium tetra decyl sulfate.  Lasers have also been used successfully.  To read more about PG click HERE and HERE.  To read about isotretinoin associated disease click HERE.  To see more images of PG click HERE.