eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Pyogenic Granuloma: Treatment & Medication

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Coauthor(s): Brett Steinberg, DO, Staff Physician, Department of Internal Medicine, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Oct 13, 2009

Treatment

Surgical Care

  • Treatment of pyogenic granulomas (PGs) most commonly consists of shave removal and electrocautery or surgical excision with primary closure.27 Removal of the lesion is indicated for bleeding due to trauma, discomfort, cosmetic distress, and diagnostic biopsy. The lesion may be completely removed during biopsy.
  • For solitary lesions, a shave excision and electrocautery under local anesthesia is the treatment of choice. To provide an adequate cure rate, all vascular granulation tissue must be removed or cauterized.
  • For large or recurrent lesions, surgical excision with primary closure may be more effective. One study reported a 43.5% recurrence rate in 23 lesions treated by shave (intradermal) excision and cautery or cautery alone. Lesions treated by full-thickness skin excision and linear closure did not recur.
  • Therapy with the pulsed-dye laser at vascular-specific 585 nm is very selective, usually requires no anesthesia, and produces excellent cosmetic results.28,29 The pulsed-dye laser works quite well for intraoral pyogenic granulomas, as observed in pregnant women. Although treatment is feasible, treatment during pregnancy is not necessary because the lesions may recur during the pregnancy and generally resolve with delivery. Various other lasers have also been shown to be effective in treating pyogenic granulomas.30,31,32,33
  • Cryotherapy or silver nitrate therapy may be effective for very small lesions; however, treatment failure rates are high.34,35
  • In pediatric cases, a eutectic mixture of local anesthetics (EMLA) applied to the lesion and surrounding skin under an occlusive dressing for 1-2 hours prior to additional intralesional anesthesia may be of significant value.

Consultations

  • Consider referral to a dermatologist if the diagnosis is in doubt or if the availability of adequate therapy is questionable.

Medication

  • Despite the necrosis, foul odor, and purulent drainage noted occasionally with pyogenic granulomas (PGs), antibiotic therapy is rarely required.

More on Pyogenic Granuloma

Overview: Pyogenic Granuloma
Differential Diagnoses & Workup: Pyogenic Granuloma
Treatment & Medication: Pyogenic Granuloma
Follow-up: Pyogenic Granuloma
Multimedia: Pyogenic Granuloma
References
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References

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  40. 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. Sep 2003;49(3):509-10. [Medline].

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

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Further Reading

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Keywords

pyogenic granuloma, PG, granuloma gravidarum, granuloma telangiectaticum, lobular capillary hemangioma, pregnancy tumor, gingival lesion, exophytic circumscribed lesion, polymorphonuclear leukocytes, satellitosis, intravenous pyogenic granuloma, nevi, warts, port-wine stain, amelanotic melanoma, human papillomavirus, bacillary angiomatosis, polymorphonuclear leukocytes

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Contributor Information and Disclosures

Author

Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Brett Steinberg, DO, Staff Physician, Department of Internal Medicine, Walter Reed Army Medical Center
Brett Steinberg, DO is a member of the following medical societies: American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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