Pyogenic Granuloma: Causes, Symptoms, Diagnosis, Prevention, and Treatment

Pyogenic Granuloma: Understanding Its Causes, Symptoms, Diagnosis, Prevention, and Treatment

Pyogenic granuloma, previously referred to as a pyogenic granuloma, is a common, acquired, benign vascular tumor that arises in tissues such as the skin and mucous membranes. Despite the misleading name, it is not related to infection but rather to hormonal imbalances, trauma, or medication use in susceptible individuals. This article provides an in-depth exploration of pyogenic granuloma, covering its causes, symptoms, diagnosis, prevention, and treatment.

Causes

Pyogenic granulomas are caused by various factors:

• Trauma: Recent minor trauma accounts for 7% of presentations. In the oral cavity, chronic minor irritation is also thought to be a common trigger. Nasal piercings have been linked to intranasal pyogenic granulomas.
• Hormonal influences: Can occur with oral contraceptive use and in 5% of pregnancies due to the hormonal changes experienced during these periods.
• Medications: Oral retinoids, protease inhibitors, targeted cancer therapies, immunosuppression drugs, and even some medications prescribed for acne or skin conditions have been associated with the development of pyogenic granulomas.
• Infection: Although there is no strong evidence for a viral etiology, Staphylococcus aureus is frequently detected. In the oral cavity, poor dental hygiene is a common association.

Symptoms

Pyogenic granulomas of the skin present as a painless red fleshy nodule, typically 5-10 mm in diameter, that grows rapidly over a few weeks. The surface is initially smooth but can ulcerate, become crusty, or bleed profusely due to its fragility. Larger lesions may develop into mushroom-like, pediculated tumors. Pyogenic granulomas are commonly found on the hands, lower lips, gingiva, nail folds, and occasionally on internal organs like the esophagus and tracheobronchial tree.

Diagnosis

Pyogenic granuloma's diagnosis often involves a thorough clinical examination. The presence of rapid growth, propensity to bleed, and characteristic appearance can help distinguish them from other vascular lesions and soft tissue infections. Histologically, pyogenic granulomas consist of lobular aggregates of capillary-sized vessels with plump endothelial cells surrounded by fibromyxoid stroma.

Prevention

Preventive measures for pyogenic granuloma include:

• Avoiding trauma: Minimizing exposure to potential injuries, such as avoiding nasal piercings or carefully monitoring children during playtime.
• Regular dental checkups: Ensuring good oral hygiene practices and regular dental examinations to prevent the development of pyogenic granulomas associated with poor dental hygiene.
• Monitoring medication use: Consulting healthcare providers about any medications that have been linked to pyogenic granuloma formation and discussing alternative options where necessary.

Treatment

Treatments for pyogenic granulomas depend on factors like location, size, number of lesions, and patient preferences. Options include:

• Surgical excision: This is typically considered the gold standard for removing pyogenic granulomas. It provides excellent cosmetic outcomes but carries the risk of recurrence, especially if not completely removed or if there is residual feed vessel left behind.
• Laser therapy: Laser surgery offers a minimally invasive approach to eliminate pyogenic granulomas while reducing the chance of recurrence compared to surgical excision.
• Topical and systemic beta-adrenergic receptor antagonists: Timolol, an FDA-approved medication for topical use in pyogenic granulomas, has shown promise in reducing tumor size and symptoms. Systemic beta-blockers may also be considered for larger or more extensive lesions.
• Hormonal therapy: In pregnant women experiencing a pregnancy tumour (pyogenic granuloma), hormone blockade can help manage the growth of the lesion. However, it is important to consult with a healthcare provider before considering this option, as it involves potential side effects on the developing fetus.