Pyogenic Granuloma (Lobular Capillary Hemangioma) Treatment & Management

Updated: Feb 21, 2020
  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
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Medical Care

If a clear provoking traumatic factor exists for the pyogenic granuloma (lobular capillary hemangioma) development, remove it. Cases of pyogenic granuloma attributed to use of medications may regress upon withdrawal of the causative agent. Guidelines for the prevention and treatment epidermal growth factor receptor inhibitor–related lesions have been published. [65]

Topical and systemic beta-adrenergic receptor antagonists have successfully treated cutaneous and mucosal pyogenic granulomas. [66, 67, 68, 69, 70]

Topical imiquimod cream, [71] alitretinoin gel, [72] and ingenol mebutate [73] have been successfully used to treat pyogenic granulomas. Oral valacyclovir resolved a giant lesion showing herpes simplex virus type–I antigens by immunohistochemistry in 2 weeks. [10] A report from Turkey described a patient with multiple pyogenic granulomas who showed clear improvement with oral erythromycin treatment. [74]

Simple table salt, [75] injectable sclerosing agents, [76] chemical cauterization with silver nitrate, [77] topical phenol for periungual lesions, [78] and photodynamic therapy with 5-aminolevulinic acid intralesional injection [79] have all been used.

Pyogenic granulomas with satellitosis that recurred after surgical excision have responded to intralesional [80] and systemic [81] steroids.

A recurrent giant pyogenic granuloma on the palm was successfully treated with intralesional bleomycin. [82]


Surgical Care

Shave, punch, or scalpel excision may be curative if the lesion is completely removed, and it provides a tissue specimen for pathologic confirmation of the diagnosis. Histologic evaluation is vital for any nonhealing lesion. [55] Curettage and electrodesiccation is often successful, either alone, or in combination, [83] and may be performed after shave removal. Among surgical options, full-thickness excision has the lowest rate of recurrence (2.94%). [18]  For large or difficult surgical areas, transarterial embolization may be an option. [84]  For large or difficult surgical areas, transarterial embolization may be an option. [84] For digital pyogenic granulomas, a trap technique using a Penrose drain helps minimize bleeding. [85]

A variety of laser modalities have been successfully used. [86, 87, 88, 89, 90] Ligation of the lesion base [91] and cryosurgery [92] have been reported to be effective for pyogenic granulomas.

Many lesions occurring in pregnancy resolve with parturition; because recurrences are higher during pregnancy, some experts recommend postponing removal until after delivery. [93]


Long-Term Monitoring

The patient should seek follow-up care as early as possible if any evidence of recurrence of the pyogenic granuloma (lobular capillary hemangioma) is present.