Pyogenic granuloma is a benign, acquired, vascular neoplasm of the skin and mucous membranes. Interestingly, it doesn’t have an infective aetiology in spite of its’ name. The term granuloma pyogenicum was first adopted because of the presumed infectious aetiology and presence of granulomatous inflammation. The exact pathogenesis is uncertain but an infective aetiology has never been proven.
The term lobular capillary haemangioma has been proposed as an alternative name in recent times.
They are common on the head, neck, fingers and periungal areas. They are small, red papules that grow rapidly and then stabilize. They are usually solitary.
They characteristically present to ED with profuse bleeding after minimal trauma.
Management in the ED involves measures to obtain haemostasis e.g pressure bandages, Kaldostat® or cauterization with silver nitrate.
Recurrent bleeding occurs if the lesion is not definitively removed. Options include: surgical excision with primary closure, shave excision at the base followed by electrocautery, cryotherapy or laser therapy.
References
Pagliai KA, Cohen BA. Pyogenic Granuloma in Children. Pediatr Dermatol [Internet]. 2004 Jan 1 [cited 2020 Aug 24];21(1):10–3. Available from: https://doi.wiley.com/10.1111/j.0736-8046.2004.21102.x
Gomes SR, Shakir QJ, Thaker P V., Tavadia JK. Pyogenic granuloma of the gingiva: A misnomer? – A case report and review of literature. J Indian Soc Periodontol [Internet]. 2013 Jul [cited 2020 Aug 24];17(4):514–9.
Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: The underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol [Internet]. 1980 Oct 1 [cited 2020 Aug 24];4(5):471–9.
Lee J, Sinno H, Tahiri Y, Gilardino MS. Treatment options for cutaneous pyogenic granulomas: A review. Vol. 64, Journal of Plastic, Reconstructive and Aesthetic Surgery. Churchill Livingstone; 2011. p. 1216–20.