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Dermatologic Manifestations of Pyogenic Granuloma (Lobular Capillary Hemangioma)

  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
 
Updated: Feb 19, 2016
 

Background

Pyogenic granuloma (lobular capillary hemangioma[1] ) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. Also see the Medscape Reference article Oral Pyogenic Granuloma.

Pyogenic granulomas are misnamed; they are neither infectious nor granulomatous. The lesion usually occurs in children and young adults as a solitary, glistening red papule or nodule that is prone to bleeding and ulceration. Pyogenic granulomas typically evolve rapidly over a period of a few weeks, most often on the head, neck, extremities, and upper trunk.

Pyogenic granuloma often arises in pregnancy (or rarely with oral contraceptive usage), particularly on the gingiva or elsewhere in the oral mucosa, and then is termed the "pregnancy tumor."

Other pyogenic granuloma variants that have been well documented include the disseminated, subcutaneous, intravenous, and medication-induced (for example, retinoid, antiretroviral, and oncologic agent) subtypes.

Removal of pyogenic granuloma is indicated to alleviate any bleeding, discomfort, cosmetic distress, and diagnostic uncertainty. A number of malignant tumors may clinically mimic pyogenic granuloma, making histopathologic confirmation important if the presentation is atypical.

Aside from cutaneous and oral lesions, pyogenic granuloma has been reported throughout the gastrointestinal tract and upper airway, at various ocular locations, the central nervous system, the bladder, and the internal vasculature. This article discusses only cutaneous and oral involvement.

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Pathophysiology

The precise mechanism for the development of pyogenic granuloma (lobular capillary hemangioma) is unknown. Trauma, hormonal influences, certain medications, viruses, underlying microscopic arteriovenous malformations, the production of angiogenic growth factors, and cytogenetic abnormalities have all been postulated to play a role. The overexpression of transcription factors P-ATF2 and STAT3 also may play a role in tumorigenesis.[2] Endothelial nitric oxide synthases (eNOS), CD34, and CD105/endoglin expression are markers of angiogenesis in pyogenic granulomas.[3, 4] . Tissue injury may trigger pathologic angiogenesis driven by FLT4, a tyrosine-kinase receptor, and the nitric acid pathway.[5] COX-2 and IL-10 may be involved in the etiopathogenesis of oral pyogenic granulomas.[6]  BRAF and RAS mutations have been identified, suggesting a true neoplastic process.[7, 8]

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Epidemiology

Frequency

United States

Pyogenic granuloma is relatively common, representing 0.5% of all skin nodules in children.[9] The pregnancy tumor variant of pyogenic granuloma occurs in up to 5% of pregnancies.[10]

International

International frequency for pyogenic granuloma is likely similar to that of the United States.

Race

The frequency of pyogenic granuloma appears to be similar in all races.

Sex

Pyogenic granulomas are equally prevalent in male and female patients, though oral mucosal lesions are twice more common in females, likely due to the pregnancy tumor phenomenon.[11]

Age

Pyogenic granuloma is rare in children younger than 6 months. The peak age of onset for cutaneous lesions is the second decade of life.[11] For patients younger than 17 years, the mean age of presentation has been reported as 6.7 years.[9] Aside from those lesions occurring in pregnancy, the frequency declines linearly with age in adulthood. Also see the Medscape article, Pediatric Pyogenic Granuloma.

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Contributor Information and Disclosures
Author

Joseph C Pierson, MD Dermatology Residency Program Director, University of Vermont College of Medicine

Joseph C Pierson, MD is a member of the following medical societies: Association of Professors of Dermatology, New England Dermatological Society, American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD Managing Member, Certified Dermatologists

Christine C Tam, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Diane Pierson, DO, to the development and writing of this article.

References
  1. Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol. 1980 Oct. 4(5):470-9. [Medline].

  2. Chen SY, Takeuchi S, Urabe K, et al. Overexpression of phosphorylated-ATF2 and STAT3 in cutaneous angiosarcoma and pyogenic granuloma. J Cutan Pathol. 2008 Aug. 35(8):722-30. [Medline].

  3. Vassilopoulos SI, Tosios KI, Panis VG, Vrotsos JA. Endothelial cells of oral pyogenic granulomas express eNOS and CD105/endoglin: an immunohistochemical study. J Oral Pathol Med. 2011 Apr. 40(4):345-51. [Medline].

  4. Vasconcelos MG, Alves PM, Vasconcelos RG, da Silveira ÉJ, Medeiros AM, de Queiroz LM. Expression of CD34 and CD105 as markers for angiogenesis in oral vascular malformations and pyogenic granulomas. Eur Arch Otorhinolaryngol. 2011 Aug. 268(8):1213-7. [Medline].

  5. Godfraind C, Calicchio ML, Kozakewich H. Pyogenic granuloma, an impaired wound healing process, linked to vascular growth driven by FLT4 and the nitric oxide pathway. Mod Pathol. 2013 Feb. 26(2):247-55. [Medline].

  6. Isaza-Guzmán DM, Teller-Carrero CB, Laberry-Bermúdez MP, González-Pérez LV, Tobón-Arroyave SI. Assessment of clinicopathological characteristics and immunoexpression of COX-2 and IL-10 in oral pyogenic granuloma. Arch Oral Biol. 2012 May. 57(5):503-12. [Medline].

  7. Groesser L, Peterhof E, Evert M, Landthaler M, Berneburg M, Hafner C. BRAF and RAS Mutations in Sporadic and Secondary Pyogenic Granuloma. J Invest Dermatol. 2016 Feb. 136 (2):481-6. [Medline].

  8. Lim YH, Douglas SR, Ko CJ, Antaya RJ, McNiff JM, Zhou J, et al. Somatic Activating RAS Mutations Cause Vascular Tumors Including Pyogenic Granuloma. J Invest Dermatol. 2015 Jun. 135 (6):1698-700. [Medline].

  9. Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases. Pediatr Dermatol. 1991 Dec. 8(4):267-76. [Medline].

  10. Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. 1996 Jul. 41(7):467-70. [Medline].

  11. Harris MN, Desai R, Chuang TY, Hood AF, Mirowski GW. Lobular capillary hemangiomas: An epidemiologic report, with emphasis on cutaneous lesions. J Am Acad Dermatol. 2000 Jun. 42(6):1012-6. [Medline].

  12. Piraccini BM, Bellavista S, Misciali C, Tosti A, de Berker D, Richert B. Periungual and subungual pyogenic granuloma. Br J Dermatol. 2010 Nov. 163(5):941-53. [Medline].

  13. Rodins K, Gramp D, James D, Kumar S. Pyogenic granuloma, port-wine stain and pregnancy. Australas J Dermatol. 2011 Nov. 52(4):e8-e10. [Medline].

  14. Cheah S, DeKoven J. Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angioma. Australas J Dermatol. 2009 May. 50(2):141-3. [Medline].

  15. Liu S, Yang C, Xu S, Yuan C, Yang S, Zhang X. Pyogenic granuloma arising as a complication of 595 nm tunable pulsed dye laser treatment of port-wine stains: report of four cases. Dermatol Surg. 2010 Aug. 36(8):1341-3. [Medline].

  16. Campbell JP, Grekin RC, Ellis CN, Matsuda-John SS, Swanson NA, Voorhees JJ. Retinoid therapy is associated with excess granulation tissue responses. J Am Acad Dermatol. 1983 Nov. 9(5):708-13. [Medline].

  17. Badri T, Hawilo AM, Benmously R, Fenniche S, Mokhtar I. Acitretin-induced pyogenic granuloma. Acta Dermatovenerol Alp Panonica Adriat. 2011 Dec. 20(4):217-218. [Medline].

  18. Teknetzis A, Ioannides D, Vakali G, Lefaki I, Minas A. Pyogenic granulomas following topical application of tretinoin. J Eur Acad Dermatol Venereol. 2004 May. 18(3):337-9. [Medline].

  19. Bouscarat F, Bouchard C, Bouhour D. Paronychia and pyogenic granuloma of the great toes in patients treated with indinavir. N Engl J Med. 1998 Jun 11. 338(24):1776-7. [Medline].

  20. Wu PA, Balagula Y, Lacouture ME, Anadkat MJ. Prophylaxis and treatment of dermatologic adverse events from epidermal growth factor receptor inhibitors. Curr Opin Oncol. 2011 Jul. 23(4):343-51. [Medline].

  21. Curr N, Saunders H, Murugasu A, Cooray P, Schwarz M, Gin D. Multiple periungual pyogenic granulomas following systemic 5-fluorouracil. Australas J Dermatol. 2006 May. 47(2):130-3. [Medline].

  22. Piguet V, Borradori L. Pyogenic granuloma-like lesions during capecitabine therapy. Br J Dermatol. 2002 Dec. 147(6):1270-2. [Medline].

  23. Freiman A, Bouganim N, O'Brien EA. Case reports: mitozantrone-induced onycholysis associated with subungual abscesses, paronychia, and pyogenic granuloma. J Drugs Dermatol. 2005 Jul-Aug. 4(4):490-2. [Medline].

  24. Devillers C, Vanhooteghem O, Henrijean A, Ramaut M, de la Brassinne M. Subungueal pyogenic granuloma secondary to docetaxel therapy. Clin Exp Dermatol. 2009 Mar. 34(2):251-2. [Medline].

  25. Paul LJ, Cohen PR. Paclitaxel-associated subungual pyogenic granuloma: report in a patient with breast cancer receiving paclitaxel and review of drug-induced pyogenic granulomas adjacent to and beneath the nail. J Drugs Dermatol. 2012 Feb. 11(2):262-8. [Medline].

  26. Sibaud V, Dalenc F, Mourey L, Chevreau C. Paronychia and pyogenic granuloma induced by new anticancer mTOR inhibitors. Acta Derm Venereol. 2011 Sep. 91(5):584-5. [Medline].

  27. Sammut SJ, Tomson N, Corrie P. Pyogenic granuloma as a cutaneous adverse effect of vemurafenib. N Engl J Med. 2014 Sep 25. 371(13):1265-7. [Medline].

  28. Higgins EM, Hughes JR, Snowden S, Pembroke AC. Cyclosporin-induced periungual granulation tissue. Br J Dermatol. 1995 May. 132(5):829-30. [Medline].

  29. Suarez-Amor O, Cabanillas M, Monteagudo B, de Las Heras C, Cacharron JM. [Disseminated pyogenic granuloma induced by erythropoietin?]. Actas Dermosifiliogr. 2009 Jun. 100(5):439-40. [Medline].

  30. Vergara A, Isarria MJ, Rodriguez-Peralto JL, Guerra A. [Disseminated lobular capillary hemangiomas]. Actas Dermosifiliogr. 2008 Jul-Aug. 99(6):494-6. [Medline].

  31. Keles MK, Yosma E, Aydogdu IO, Simsek T, Park TH. Multiple Subungual Pyogenic Granulomas Following Levothyroxine Treatment. J Craniofac Surg. 2015 Sep. 26 (6):e476-7. [Medline].

  32. Wollina U. Multiple eruptive periungual pyogenic granulomas during anti-CD20 monoclonal antibody therapy for rheumatoid arthritis. J Dermatol Case Rep. 2010 Dec 19. 4(3):44-6. [Medline]. [Full Text].

  33. Patruno C, Balato N, Cirillo T, Napolitano M, Ayala F. Periungual and subungual pyogenic granuloma following anti-TNF-a therapy: is it the first case?. Dermatol Ther. 2013 Nov-Dec. 26(6):493-5. [Medline].

  34. Johnson TM, Demsar WJ, Herold RW, Bisch FC, Gerlach RC, Swiec GD. Pyogenic granuloma occurring in a postmenopausal woman on hormone replacement therapy. US Army Med Dep J. 2011 Jan-Mar. 86-90. [Medline].

  35. Qadir SN, Manzur A, Raza N. Multiple disseminated pyogenic granulomas. J Coll Physicians Surg Pak. 2013 Aug. 23(8):588-9. [Medline].

  36. Browning JC, Eldin KW, Kozakewich HP, Mulliken JB, Bree AF. Congenital disseminated pyogenic granuloma. Pediatr Dermatol. 2009 May-Jun. 26(3):323-7. [Medline].

  37. Palmero ML, Pope E. Eruptive pyogenic granulomas developing after drug hypersensitivity reaction. J Am Acad Dermatol. 2009 May. 60(5):855-7. [Medline].

  38. Netchiporouk E, Moreau L, Ramirez LP, Castillo PA, Bravo FP, Del Solar MC, et al. Eruptive Disseminated Pyogenic Granulomas following Lightning Injury. Dermatology. 2015 Feb 18. [Medline].

  39. Nthumba PM. Giant pyogenic granuloma of the thigh: a case report. J Med Case Reports. 2008 Mar 31. 2:95. [Medline]. [Full Text].

  40. Zaynoun ST, Juljulian HH, Kurban AK. Pyogenic granuloma with multiple satellites. Arch Dermatol. 1974 May. 109(5):689-91. [Medline].

  41. Cooper PH, Mills SE. Subcutaneous granuloma pyogenicum. Lobular capillary hemangioma. Arch Dermatol. 1982 Jan. 118(1):30-3. [Medline].

  42. Cooper PH, McAllister HA, Helwig EB. Intravenous pyogenic granuloma. A study of 18 cases. Am J Surg Pathol. 1979 Jun. 3(3):221-8. [Medline].

  43. El Hayderi L, Paurobally D, Fassotte MF, André J, Arrese JE, Sadzot-Delvaux C, et al. Herpes simplex virus type-I and pyogenic granuloma: a vascular endothelial growth factor-mediated association?. Case Rep Dermatol. 2013. 5(2):236-43. [Medline]. [Full Text].

  44. Vázquez-Martínez OT, González-Betancourt A, Barboza-Cerda MC, González-González SE, Lugo-Trampe Á, Welsh O, et al. Human papillomavirus type 2 associated with pyogenic granuloma in patients without clinical evidence of warts. Int J Dermatol. 2015 Oct 22. [Medline].

  45. Truss L, Dobin SM, Donner LR. Deletion (21)(q21.2q22.12) as a sole clonal cytogenetic abnormality in a lobular capillary hemangioma of the nasal cavity. Cancer Genet Cytogenet. 2006 Oct 1. 170(1):69-70. [Medline].

  46. Jose RM, Bennett A, Holmes J. Spitz naevi presenting as pyogenic granulomata. Br J Plast Surg. 2005 Oct. 58(7):1037-9. [Medline].

  47. Cordoro KM, Gupta D, Frieden IJ, McCalmont T, Kashani-Sabet M. Pediatric melanoma: results of a large cohort study and proposal for modified ABCD detection criteria for children. J Am Acad Dermatol. 2013 Jun. 68(6):913-25. [Medline].

  48. Schade AT, Raymond AC, Amirfeyz R. If it is not healing, do worry about it!. BMJ Case Rep. 2013 Jan 10. 2013:[Medline].

  49. Azzopardi EA, Xuereb CB, Iyer S. Pyogenic granuloma as a surrogate indicator of deep seated foreign bodies: a case report. Cases J. 2009 Aug 5. 2:7354. [Medline]. [Full Text].

  50. Lee GK, Suh KJ, Lee JH, Lee JY, Yang I, Koh SH, et al. Lobular capillary hemangioma in the soft tissue of the finger: sonographic findings. Skeletal Radiol. 2010 Nov. 39(11):1097-102. [Medline].

  51. Kikusawa A, Oka M, Shimizu H, Tsujimoto M, Marui Y, Yokogawa S, et al. Subcutaneous lobular capillary hemangioma with sonography and computed tomography findings. Eur J Dermatol. 2012 Mar-Apr. 22(2):276-7. [Medline].

  52. Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J, Llambrich A, et al. Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010 Dec. 163(6):1229-37. [Medline].

  53. Zaballos P, Rodero J, Serrano P, Cuellar F, Guionnet N, Vives JM. Pyogenic granuloma clinically and dermoscopically mimicking pigmented melanoma. Dermatol Online J. 2009 Oct 15. 15(10):10. [Medline].

  54. Moscarella E, Zalaudek I, Agozzino M, Vega H, Cota C, Catricalà C, et al. Reflectance confocal microscopy for the evaluation of solitary red nodules. Dermatology. 2012. 224(4):295-300. [Medline].

  55. Waraasawapati S, Koonmee S, Kusama H, Kudo M. Extramedullary hematopoiesis in pyogenic granuloma. Pathol Int. 2013 Oct. 63(10):492-5. [Medline].

  56. Trindade F, Tellechea O, Torrelo A, Requena L, Colmenero I. Wilms tumor 1 expression in vascular neoplasms and vascular malformations. Am J Dermatopathol. 2011 Aug. 33(6):569-72. [Medline].

  57. North PE, Waner M, Mizeracki A, Mihm MC Jr. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol. 2000 Jan. 31(1):11-22. [Medline].

  58. Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011 Aug. 19(8):1079-95. [Medline].

  59. Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using ß-adrenergic receptor antagonists. Pediatr Dermatol. 2014 Mar-Apr. 31(2):203-7. [Medline].

  60. Khorsand K, Maier M, Brandling-Bennett HA. Pyogenic granuloma in a 5-month-old treated with topical timolol. Pediatr Dermatol. 2015 Jan-Feb. 32(1):150-1. [Medline].

  61. Tritton SM, Smith S, Wong LC, Zagarella S, Fischer G. Pyogenic granuloma in ten children treated with topical imiquimod. Pediatr Dermatol. 2009 May-Jun. 26(3):269-72. [Medline].

  62. Maloney DM, Schmidt JD, Duvic M. Alitretinoin gel to treat pyogenic granuloma. J Am Acad Dermatol. 2002 Dec. 47(6):969-70. [Medline].

  63. Ceyhan AM, Basak PY, Akkaya VB, Yildirim M, Kapucuoglu N. A case of multiple, eruptive pyogenic granuloma developed on a region of the burned skin: can erythromycin be a treatment option?. J Burn Care Res. 2007 Sep-Oct. 28(5):754-7. [Medline].

  64. Carvalho RA, Neto V. Letter: Polidocanol sclerotherapy for the treatment of pyogenic granuloma. Dermatol Surg. 2010 Jun. 36 Suppl 2:1068-70. [Medline].

  65. Quitkin HM, Rosenwasser MP, Strauch RJ. The efficacy of silver nitrate cauterization for pyogenic granuloma of the hand. J Hand Surg Am. 2003 May. 28(3):435-8. [Medline].

  66. Losa Iglesias ME, Becerro de Bengoa Vallejo R. Topical phenol as a conservative treatment for periungual pyogenic granuloma. Dermatol Surg. 2010 May. 36(5):675-8. [Medline].

  67. Lee DJ, Kim EH, Jang YH, Kim YC. Photodynamic therapy with 5-aminolevulinic acid intralesional injection for pyogenic granuloma. Arch Dermatol. 2012 Jan. 148(1):126-8. [Medline].

  68. Parisi E, Glick PH, Glick M. Recurrent intraoral pyogenic granuloma with satellitosis treated with corticosteroids. Oral Dis. 2006 Jan. 12(1):70-2. [Medline].

  69. Tursen U, Demirkan F, Ikizoglu G. Giant recurrent pyogenic granuloma on the face with satellitosis responsive to systemic steroids. Clin Exp Dermatol. 2004 Jan. 29(1):40-1. [Medline].

  70. Daya M. Complete resolution of a recurrent giant pyogenic granuloma on the palm of the hand following single dose of intralesional bleomycin injection. J Plast Reconstr Aesthet Surg. 2010 Mar. 63(3):e331-3. [Medline].

  71. Ghodsi SZ, Raziei M, Taheri A, Karami M, Mansoori P, Farnaghi F. Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial. Br J Dermatol. 2006 Apr. 154(4):671-5. [Medline].

  72. Lee J, Sinno H, Tahiri Y, Gilardino MS. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg. 2011 Sep. 64(9):1216-20. [Medline].

  73. Tsai KY, Wang WH, Chang GH, Tsai YH. Treatment of pregnancy-associated oral pyogenic granuloma with life-threatening haemorrhage by transarterial embolisation. J Laryngol Otol. 2015 Jun. 129 (6):607-10. [Medline].

  74. Yang C, Liu S. Treatment of giant pyogenic granuloma with the Nd/YAG holmium laser: a case report. J Cosmet Laser Ther. 2013 Aug. 15(4):225-7. [Medline].

  75. Asnaashari M, Mehdipour M, MoradiAbbasabadi F, Azari-Marhabi S. Expedited removal of pyogenic granuloma by diode laser in a pediatric patient. J Lasers Med Sci. 2015 Winter. 6(1):40-4. [Medline]. [Full Text].

  76. Fekrazad R, Nokhbatolfoghahaei H, Khoei F, Kalhori KA. Pyogenic Granuloma: Surgical Treatment with Er:YAG Laser. J Lasers Med Sci. 2014 Fall. 5(4):199-205. [Medline]. [Full Text].

  77. Holbe HC, Frosch PJ, Herbst RA. Surgical pearl: ligation of the base of pyogenic granuloma--an atraumatic, simple, and cost-effective procedure. J Am Acad Dermatol. 2003 Sep. 49(3):509-10. [Medline].

  78. Mirshams M, Daneshpazhooh M, Mirshekari A, Taheri A, Mansoori P, Hekmat S. Cryotherapy in the treatment of pyogenic granuloma. J Eur Acad Dermatol Venereol. 2006 Aug. 20(7):788-90. [Medline].

  79. Manus DA, Sherbert D, Jackson IT. Management considerations for the granuloma of pregnancy. Plast Reconstr Surg. 1995 May. 95(6):1045-50. [Medline].

  80. Alexander AM Jr, Koh JK. Granuloma pyogenicum (pyogenic granuloma) causing severe anemia. Arch Dermatol. 1972 Jul. 106(1):128. [Medline].

 
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Pyogenic granuloma on the neck of the young girl. Courtesy of Jeffrey P. Callen, MD.
Multiple recurrent pyogenic granulomas on the neck of a young girl. Courtesy of Jeffrey P. Callen, MD.
Pyogenic granuloma on the hand. Courtesy of Jeffrey P. Callen, MD.
 
 
 
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