eMedicine Specialties > Emergency Medicine > Dermatology

Granuloma, Annulare and Pyogenic: Follow-up

Author: Richard Lichenstein, MD, Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Sep 18, 2008

Follow-up

Further Outpatient Care

  • Further outpatient care is needed to follow the progress of lesions because as many as 20% of children with granuloma annulare experience recurrence.
  • Local recurrence after treatment of pyogenic granuloma by any method is not uncommon. In a one series, most of patients with uncomplicated pyogenic granuloma were treated with single shave excision and electrocautery, with no recurrences.3

Inpatient & Outpatient Medications

  • Granuloma annulare is a self-limited cosmetic disease that rarely needs treatment and rarely produces sequelae.
  • Many drug therapies have been proposed, but none are known to be efficacious. No outpatient medications are used for the treatment of pyogenic granuloma, which is usually managed by extirpation.

Complications

  • In cases of granuloma annulare without other etiology of the subcutaneous nodules, no complications are encountered.
  • The principal complication associated with pyogenic granuloma is hemorrhage, which can be significant and can require intervention.

Prognosis

  • The prognosis of granuloma annulare is excellent, as the lesions usually regress spontaneously. Fifty to 70% with the localized type resolve after 1-2 years. The generalized type is less likely to resolve spontaneously.
  • The prognosis of pyogenic granuloma is also excellent.

Patient Education

  • Reassurance and referral are the principal and essential steps in patient education.

Miscellaneous

Special Concerns

  • Pyogenic granuloma in pregnancy
    • PG is common in pregnancy, with intraoral mucosal lesions appearing in 5% of pregnancies and in some unknown fraction of patients taking oral contraceptives.
    • Although the tumor mass often regresses after delivery or in response to adjustment of the contraceptive medication, spontaneous recurrences may be observed.
    • Etiology in pregnant women may be related to gingival inflammation, as the prevalence is reported to be less in patients with better oral hygiene.
 


More on Granuloma, Annulare and Pyogenic

Overview: Granuloma, Annulare and Pyogenic
Differential Diagnoses & Workup: Granuloma, Annulare and Pyogenic
Treatment & Medication: Granuloma, Annulare and Pyogenic
Follow-up: Granuloma, Annulare and Pyogenic
References
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References

  1. Ziemer M, Grabner T, Eisendle K, Baltaci M, Zelger B. Granuloma annulare - a manifestation of infection with Borrelia?. J Cutan Pathol. Jun 18 2008;[Medline].

  2. Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. Mar 2004;38(3):494-7. [Medline].

  3. Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. Jan-Feb 2004;21(1):10-3. [Medline].

  4. Arroyo MP. Generalized granuloma annulare. Dermatol Online J. Oct 2003;9(4):13. [Medline].

  5. Dillman AM, Miller RC, Hansen RC. Multiple pyogenic granulomata in childhood. Pediatr Dermatol. Mar 1991;8(1):28-31. [Medline].

  6. Felner EI, Steinberg JB, Weinberg AG. Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics. Dec 1997;100(6):965-7. [Medline].

  7. Grimalt R, Caputo R. Symmetric pyogenic granuloma. J Am Acad Dermatol. Oct 1993;29(4):652. [Medline].

  8. Medlock MD, McComb JG, Raffel C, Gonzalez-Gomez I. Subcutaneous palisading granuloma of the scalp in childhood. Pediatr Neurosurg. 1994;21(2):113-6. [Medline].

  9. Mooney MA, Janniger CK. Pyogenic granuloma. Cutis. Mar 1995;55(3):133-6. [Medline].

  10. Pomeranz AJ, Fairley JA. The systematic evaluation of the skin in children. Pediatr Clin North Am. Feb 1998;45(1):49-63. [Medline].

  11. Scheinfeld NS. Pyogenic granuloma. Skinmed. Jan-Feb 2008;7(1):37-9. [Medline].

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

  13. Tan HH, Goh CL. Granuloma annulare: a review of 41 cases at the National Skin Centre. Ann Acad Med Singapore. Nov 2000;29(6):714-8. [Medline].

  14. Tay YK, Weston WL, Morelli JG. Treatment of pyogenic granuloma in children with the flashlamp-pumped pulsed dye laser. Pediatrics. Mar 1997;99(3):368-70. [Medline].

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Further Reading

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Keywords

granuloma annulare, pyogenic granuloma, skin nodule, GA, dermatosis, PG, vascular tumor of skin and mucous membrane, papule, nodule, peduncle, subcutaneous GA, self-limited dermatosis, disorder of angiogenesis, sclerosis, lymphedema, joint ankylosis, necrobiosis lipoidica diabeticorum, rheumatoid nodules, benign vascular tumor

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Contributor Information and Disclosures

Author

Richard Lichenstein, MD, Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine
Richard Lichenstein, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, Department of Emergency Medicine, University Hospital Health Systems in Cleveland
Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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