What medications may trigger pyogenic granuloma (lobular capillary hemangioma)?

Updated: Feb 21, 2020
  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
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Systemic retinoids may occasionally trigger pyogenic granuloma–like lesions. [23] These occurred more frequently just after the approval of isotretinoin. In current practice, a lower initial dose is used and this phenomenon is unusual. Reports have also described pyogenic granulomas occurring with the use of acitretin [24] and even topical retinoids. [25]

Antiretrovirals have been associated with the development of pyogenic granulomas, predominantly of the great toes. [26]

Periungal pyogenic granulomas occurring during epidermal growth factor receptor inhibitor therapy are a mounting problem for oncology patients, arising after 2 months of drug exposure. Nailfold paronychia and pyogenic granuloma changes occur in up to 24% of patients on panitumumab. [27]

Other antineoplastic agents associated with pyogenic granuloma development include the pyrimidine analog 5-fluorouracil, [28] its prodrug capecitabine, [29] mitoxantrone (an anthracenedione), [30] the taxanes docetaxel [31] and paclitaxel, [32] mTOR inhibitors, [33] vemurafenib, [34] blinatumomab, [35] and ramucirumab. [36]

In addition, pyogenic granulomas have occurred with the use of cyclosporine, [37] erythropoietin, [38, 39] levothyroxine, [40] anti-CD 20 monoclonal antibody therapy, [41] and following anti–tumor necrosis factor-alpha therapy. [42]

The pregnancy tumor variant most often occurs in the second or third trimester. Cases arising with the use of oral contraceptives and hormone replacement therapy have been reported. [43]

Rare multiple pyogenic granuloma lesions may be grouped or eruptive and disseminated in nature. [44] Congenital disseminated pyogenic granulomas have been reported. [45]

Eruptive disseminated pyogenic granulomas have developed following a drug hypersensitivity reaction [46] and after burn injuries, including lightning strike. [47]

Adolescents and young adults are more prone to develop multiple recurrent satellite lesions after prior attempts at removal, especially on the trunk.

Untreated pyogenic granulomas eventually atrophy, become fibromatous, and slowly regress.

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