Pyogenic granuloma

Definition/diagnostic criteria Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes, characterised by an overgrowth of tissue due to an exaggerated inflammatory response. It is also referred to as lobular capillary haemangioma. The diagnostic criteria are primarily based on clinical presentation, including rapid growth, bleeding propensity and characteristic appearance. The lesion is typically a small, raised, reddish nodule that can vary in size from a few millimetres to several centimetres

Epidemiology Pyogenic granuloma is common and can affect individuals of any age, although it is more prevalent in children, young adults and pregnant women. There is no clear association with ethnicity and both genders are equally affected

Diagnosis
Clinical features: Pyogenic granuloma typically presents as a solitary, shiny, red or purple nodule that may be pedunculated or sessile.

• In darker skin types, pyogenic granuloma may appear darker than in lighter skin types, with a bluish or brownish hue.
• The size can range from a few millimetres to several centimetres.
• The lesion commonly occurs on the skin, particularly the hands, fingers, face and neck, but can also develop on mucous membranes, including the oral cavity.
• It tends to grow rapidly over a period of weeks before stabilising.
• The lesion is prone to bleeding, even with minimal trauma, and may become ulcerated or crusted.

Although the diagnosis is often straightforward the main differential diagnosis is that of a hypomelanotic melanoma, which tend to bleed less than pyogenic granuloma. Other features that may increase the level of suspicion include no clear history of trauma and an atypical site or age group.

Investigations: The diagnosis of pyogenic granuloma is primarily clinical. Suspicious lesions needing diagnosis (as well as treatment) are best removed surgically (deep curettage and cautery, or excision) and sent for urgent histology.

Treatment Treatment of pyogenic granuloma is primarily surgical, with various options available depending on the size and location of the lesion. Small lesions may be treated with a 2-week trial of a daily covering of table salt covered in surgical tape or clingfilm with Vaseline to protect the surrounding skin.  In some cases, particularly in pregnant women, the lesion may resolve spontaneously, and a watch-and-wait approach may be appropriate.

Prognosis The prognosis for pyogenic granuloma is generally excellent, particularly with surgical treatment. The condition is benign, and malignant transformation is extremely rare. However, the lesion has a tendency to recur, particularly if not completely excised. Recurrence rates are higher in younger patients and in certain locations, such as the fingers. Following treatment, there may be residual scarring or pigmentary changes, particularly in individuals with darker skin types.