Imaging Studies

Sonographic features of digital subcutaneous pyogenic granulomas have been described.^[56]Subcutaneous pyogenic granuloma sonography and computed tomography findings have also been reported.^[57]

Procedures

Dermoscopy patterns for pyogenic granuloma have been described.^[58]A dermoscopic rainbow pattern has been reported.^[59]Even dermoscopically, pyogenic granulomas may be indistinguishable from malignant melanoma.^[60]

Reflectance confocal microscopic findings of solitary red nodules, including pyogenic granuloma, have been published.^[61]

A specimen for histologic examination may be obtained by shave, punch, scalpel, or laser excision.

Histologic Findings

The histopathologic findings in all variants of pyogenic granuloma are similar. Early lesions resemble granulation tissue (numerous capillaries and venules with plump endothelial cells arrayed radially toward the skin surface amidst an edematous stroma containing a mixed inflammatory infiltrate). Often, overlying erosive or ulcerative changes are noted. The matured polypoid lesion exhibits a fibromyxoid stroma separating the lesion into lobules. Reepithelialization of the surface and a peripheral hyperplastic adnexal epithelioid collarette may be noted, and less inflammatory infiltrate is present. A regressing pyogenic granuloma displays extensive fibrosis.

Extramedullary hematopoiesis is seen histologically in 10% of pyogenic granulomas.^[62]Wilms tumor 1 protein expression is positive in vascular proliferations such as pyogenic granuloma.^[63]Endothelial GLUT1 immunohistochemical expression is positive in infantile hemangioma, but negative in pyogenic granuloma.^[64]

The intravenous variant has less lobulation and is connected to the wall of a vein by a stalk.

Treatment & Management

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Media Gallery

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.

of 3

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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.

Sections Pyogenic Granuloma (Lobular Capillary Hemangioma)
Overview
Presentation
DDx
Workup
Treatment
Questions & Answers
Media Gallery
References

Pyogenic Granuloma (Lobular Capillary Hemangioma) Workup

Imaging Studies

Procedures

Histologic Findings

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