Treating A Patient With A Solitary Vascular Soft Tissue Mass On The Hallux

Kristine Hoffman, DPM

What You Should Know About Treating Pyogenic Granulomas

When it comes to pyogenic granulomas, there are several non-surgical treatment modalities, including topical agents, chemical cautery and intralesional injections.

   Both topical imiquimod cream and alitretinoin gel (Panretin, Eisai) are reportedly successful topical treatments for pyogenic granuloma.33,34 Chemical cauterization with silver nitrate and topical phenol are treatment options although a recurrence rate of up to 43.5 percent has occurred with cautery treatment.29,35,36 In addition, injectable sclerosing agents, intralesional steroids, intralesional bleomycin and photodynamic therapy with 5-aminolevulinic acid intralesional injection are reportedly successful treatment modalities for pyogenic granuloma and recurrent lesions.37-40 Following a retrospective review of treatment modalities, Lee and colleagues recommended cauterization with silver nitrate as the initial non-surgical treatment for pyogenic granuloma.41

   Several surgical options for the treatment of pyogenic granuloma exist. These treatments include shave, punch, curettage and scalpel excision. Researchers have also shown various laser modalities, as well as cryosurgery, to be successful treatment modalities for pyogenic granuloma.42,43 Full-thickness surgical excision has the lowest rate of recurrence at 2.94 percent and is the recommended treatment modality for smaller lesions in non-cosmetically sensitive areas.41

In Conclusion

Pyogenic granulomas are commonly occurring, benign skin lesions that are more appropriately called lobular capillary hemangioma. The lesions frequently arise secondary to trauma or pregnancy. The recommended treatment for pyogenic granuloma includes cauterization with silver nitrate and full thickness surgical excision.

   Dr. Hoffman is in private practice in Boulder, Colo.

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9. Pierson JC, Tam CC. Dermatologic manifestations of pyogenic granuloma (lobular capillary hemangioma). Medscape. Available at . Published Feb. 27, 2014. Accessed April 2, 2014.

10. Hemady N. Growing plantar lesion following trauma. Am Fam Physician. 2006;74(7):1173-1174.

11. Cheah S, DeKoven J. Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angioma. Australas J Dermatol. 2009;50(2):141-3.

12. Liu S, Yang C, Xu S, et al. Pyogenic granuloma arising as a complication of 595 nm tunable pulsed dye laser treatment of port-wine stains: report of four cases. Dermatol Surg. 2010;36(8):1341-3.

13. Campbell JP, Grekin RC, Ellis CN, et al. Retinoid therapy is associated with excess granulation tissue responses. J Am Acad Dermatol. 1983;9(5):708-13.

14. Badri T, Hawilo AM, Benmously R, et al. Acitretin-induced pyogenic granuloma. Acta Dermatovenerol Alp Panonica Adriat. 2011;20(4):217-218.

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