Pyogenic Granuloma

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Synonyms: lobular capillary haemangioma

Pyogenic granulomata are common benign vascular lesions of the skin and mucosa. They are not infective, purulent or granulomatous (as the name might suggest) - rather, a reactive inflammatory mass of blood vessels and a few fibroblasts within the dermis of the skin.

  • This is not fully understood: rapid growth occurs in response to an unknown stimulus that triggers endothelial proliferation and angiogenesis.
  • Trauma and burns can provoke the sequence but frequently there is no identifiable cause.
  • Bacterial infection may be involved. Staphylococcus aureus is often isolated from the lesion.
  • Other suggested causes include viral oncogenes, hormonal influences (pregnancy, oral contraceptive pill) and cytogenetic abnormalities.
  • They have also been associated with certain medications:
    • Systemic and topical retinoids[2, 3].
    • Indinavir (a protease inhibitor)[4].
    • Chemotherapy agents such as fluorouracil and paclitaxel[5, 6].
  • Mean age for presentation is 6-7 years. Thereafter, there is a decrease in incidence with age[7]. They represent 0.5% of skin nodules in children[8].
  • They are more common in women, due to frequent formation on the gingiva during pregnancy (pregnancy tumour, or epulis gravidarum) - occurring in up to 5% of pregnancies[9].
  • Solitary[10]red, purple or yellow papule or nodule arising from normal skin.
  • Size varies from a few millimetres in diameter to several centimetres.
  • Polypoid appearance - they often develop a stalk or 'collarette' of scale at the base.
  • Friable lesion - they are often seen to be bleeding, crusted or ulcerated.
PYOGENIC GRANULOMA -CLOSE UP TOP
PYOGENIC GRANULOMA -CLOSE UP SIDE
PYOGENIC GRANULOMA
  • Rapid eruption and growth over a few weeks.
  • Most commonly, they occur on the head, neck and extremities (particularly the fingers).
  • They occasionally occur on the external genitalia[11].
  • In pregnancy, they are most likely to occur on the maxillary intraoral mucosal surface during the second and third trimesters.
  • They have also been reported on the labial mucosa in men[12].
  • Rarely, multiple satellite lesions may develop - especially in adolescents and young adults after prior attempts to remove the original lesion.

Includes:

Some advocate sending all lesions for histological confirmation. This is because the vascular nature of the lesion makes dermoscopy unreliable[14]. However, there may be occasions on which dermoscopy may be considered sufficient (eg, typical appearance in a very young child)[15].

  • Most patients seek help because of the bleeding associated with the lesion.
  • Treatment options include curettage and cautery, shave excision, excision with primary closure and laser therapy.
  • Cryotherapy may work but does not provide a histological specimen for diagnosis.
  • One study reported the use of sclerotherapy employing sodium tetradecyl sulfate as the sclerosant. As with cryotherapy, this technique does not provide a histological specimen[16]. Moreover, sodium tetradecyl sulfate is only licensed for the treatment of varicose veins in the UK, so the usual considerations concerning the use of unlicensed medicines apply.
  • For assistance with diagnosis and removal.
  • Following a recurrence.
  • Where a nodular melanoma is suspected.

Pain and bleeding are the most usual problems associated with this lesion.

  • Pyogenic granulomata are benign lesions.
  • Untreated lesions will atrophy eventually but only a minority will spontaneously involute within six months.
  • Recurrence rates following treatment can be common regardless of treatment modality.
  • Pregnancy tumours tend to regress spontaneously following childbirth so treatment should be postponed accordingly.

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Further reading & references

  • Kumar P, Das A, Mondal A, et al; Pyogenic granuloma-like basal cell carcinoma on the abdomen: A deceptive presentation. Indian Dermatol Online J. 2016 Sep-Oct 7(5):446-448.
  1. Pyogenic Granuloma; DermNet NZ
  2. Badri T, Hawilo AM, Benmously R, et al; Acitretin-induced pyogenic granuloma. Acta Dermatovenerol Alp Panonica Adriat. 2011 20(4):217-8.
  3. Tinoco MP, Tamler C, Maciel G, et al; Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic. Int J Dermatol. 2008 Sep 47(9):953-6. doi: 10.1111/j.1365-4632.2008.03662.x.
  4. Wollina U; Multiple eruptive periungual pyogenic granulomas during anti-CD20 monoclonal antibody therapy for rheumatoid arthritis. J Dermatol Case Rep. 2010 Dec 19 4(3):44-6. doi: 10.3315/jdcr.2010.1050.
  5. Curr N, Saunders H, Murugasu A, et al; Multiple periungual pyogenic granulomas following systemic 5-fluorouracil. Australas J Dermatol. 2006 May 47(2):130-3.
  6. Paul LJ, Cohen PR; Paclitaxel-associated subungual pyogenic granuloma: report in a patient with breast cancer receiving paclitaxel and review of drug-induced pyogenic granulomas adjacent to and beneath the nail. J Drugs Dermatol. 2012 Feb 11(2):262-8.
  7. Durgun M, Selcuk CT, Ozalp B, et al; Multiple disseminated pyogenic granuloma after second degree scald burn: a rare two case. Int J Burns Trauma. 2013 Apr 18 3(2):125-9. Print 2013.
  8. Kamal R, Dahiya P, Puri A; Oral pyogenic granuloma: Various concepts of etiopathogenesis. J Oral Maxillofac Pathol. 2012 Jan 16(1):79-82. doi: 10.4103/0973-029X.92978.
  9. Jafarzadeh H, Sanatkhani M, Mohtasham N; Oral pyogenic granuloma: a review. J Oral Sci. 2006 Dec 48(4):167-75.
  10. Marghoob A et al; An Atlas of Dermoscopy, Second Edition, 2012.
  11. Arikan DC, Kiran G, Sayar H, et al; Vulvar pyogenic granuloma in a postmenopausal woman: case report and review of the literature. Case Rep Med. 2011 2011:201901. doi: 10.1155/2011/201901. Epub 2011 Sep 8.
  12. Ravi V, Jacob M, Sivakumar A, et al; Pyogenic granuloma of labial mucosa: A misnomer in an anomolous site. J Pharm Bioallied Sci. 2012 Aug 4(Suppl 2):S194-6. doi: 10.4103/0975-7406.100269.
  13. Pyogenic granuloma; Primary Care Dermatology Society, 2012
  14. Zaballos P, Carulla M, Ozdemir F, et al; Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010 Dec 163(6):1229-37. doi: 10.1111/j.1365-2133.2010.10040.x.
  15. Lacarrubba F, Caltabiano R, Micali G; Dermoscopic and histological correlation of an atypical case of pyogenic granuloma. Pediatr Dermatol. 2013 Jul 30(4):499-501. doi: 10.1111/pde.12123. Epub 2013 Mar 14.
  16. Sacchidanand S, Purohit V; Sclerotherapy for the treatment of pyogenic granuloma. Indian J Dermatol. 2013 Jan 58(1):77-8. doi: 10.4103/0019-5154.105317.
Original Author:
Dr Chloe Borton
Current Version:
Dr Laurence Knott
Peer Reviewer:
Dr Hannah Gronow
Document ID:
4086 (v23)
Last Checked:
30 November 2016
Next Review:
29 November 2021

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.