Annulare and Pyogenic Granuloma Treatment & Management

  • Author: Richard Lichenstein, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 22, 2012
 

Prehospital Care

  • Granuloma annulare: Prehospital care is not a consideration for patients with granuloma annulare, which is a nuisance lesion.
  • Pyogenic granuloma
    • Patients with pyogenic granuloma may present with acute bleeding from the vascular lesions, particularly when they are intraoral.
    • In the prehospital setting, bleeding should be controlled by direct pressure, and the airway should be secured if necessary.
    • IV access may be indicated if hemorrhage is severe.
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Emergency Department Care

  • Granuloma annulare
    • Granuloma annulare rarely requires any treatment since spontaneous resolution is common.
    • Medical and surgical interventions should be avoided unless absolutely necessary.
  • Pyogenic granuloma
    • For patients who present with hemorrhage, bleeding often may be controlled with direct pressure.
    • A vasoconstrictor packing (eg, cocaine or tetracaine with adrenaline) sometimes may be needed.
    • When bleeding is refractory or recurrent, sclerotherapy by direct injection of 1-2 mL of 1% sodium tetradecyl sulfate into the vascular plexus is usually effective and may even provide a definitive cure.
    • Compress the lesion for 15 minutes following injection. Sclerotherapy usually is necessary in order to allow time for the tumor vessels to go into spasm.
    • Effective treatment includes excision (although this may be difficult if the lesion is extensive), electrodesiccation, curettage, chemical cauterization, and injection sclerotherapy. Carbon dioxide and argon lasers have been used successfully for superficial cases of pyogenic granuloma. Pulsed-dye laser also has been shown effective in the treatment of pyogenic granulomas when the lesion is superficial and of less than 0.5 cm thickness. Advantages of excision and electrocautery are ease of use and lack of recurrences according to one recent study in children.
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Consultations

If diagnosis is unproven, follow-up care with a dermatologist is indicated.

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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.

Specialty Editor Board

Edward A Michelson, MD  Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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  Chair, Department of Emergency Medicine, LeConte 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.

References

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  19. 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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