A 53-year-old Man With Pyogenic Granuloma

Gary Goldenberg, MD


March 10, 2010


Multiple treatment options for pyogenic granuloma have been described. Surgical therapy has dominated the literature. Multiple approaches to remove the lesions have been attempted, including surgical excision with primary closure, shave excision at the base followed by electrocautery, cryotherapy with liquid nitrogen, carbon dioxide laser vaporization, and pulsed-dye laser therapy.[1]

Giblin and colleagues[14] examined 408 cases of pyogenic granuloma and examined treatment as well as recurrence rates. In this series, 80% of the lesions were treated by surgical excision, and 19% were treated by curettage, shave excision, or cautery or a combination of these. The overall recurrence rate was 5%, with 20 lesions recurring in 18 patients. Most recurrent lesions were located on the fingers (50%) and head or neck (35%). The recurrence rate was 3.7% in the 326 lesions treated by surgical excision. The intraoral recurrence rate in those treated by shave excision was 13%.

Multiple approaches with laser therapy have also been tried. Tay and colleagues evaluated the use of a flashlamp-pumped pulsed-dye laser in children, who were a mean of 3.4 years old.[15] The average lesion size was 4 mm. In total, 22 children with pyogenic granulomas were treated with vascular-specific, 585 nm, pulsed (450 microseconds)-dye laser using a 5-mm spot size with laser energy of 6 to 7 J/cm.2 Topical or systemic anesthesia was not used. Retreatments, if necessary, were administered every 2 weeks until lesion completely resolved. Posttreatment care consisted of twice-daily application of bacitracin ointment. Overall, 20 patients (91%) had complete resolution with laser therapy. Most patients (8 patients or 40%) required 2 treatments, whereas 5 patients (25%) required 1 treatment, and 6 patients (30%) required 3 treatments for complete resolution. None of the patients who achieved complete resolution had a recurrence between 6 months and 3 years of follow-up, and no scarring was noted.

Raulin and colleagues[16] used the combined continuous-wave/pulsed-CO2 laser to treat 100 pyogenic granulomas. Mean patient age was 26.8 years (range, 6 months-84 years). Most lesions (n = 58) were located on the head and neck, including the cheek (18), lips (12) tongue (1), and other (27). Of the rest, 17 lesions were located on the fingers, and 25 were located elsewhere on the skin. Most of the lesions (64 cases) measured between 0.3 and 0.6 cm in size. Ninety-eight cases were removed in a single session and only 2 recurrences were noted by the investigators. The treatment was rated as "very satisfactory" by 63 patients and "satisfactory" by the other 37 patients.

Nonsurgical treatment of a recurrent PG with imiquimod 5% cream was recently reported.[17] The patient in this report applied imiquimod 5% twice weekly for 14 weeks to a PG that was previously treated with shave excision and base electrocautery on 2 separate occasions. The lesion resolved completely without scarring. Imiquimod is a low-molecular-weight imidazoquinoline approved by the Food and Drug Administration for treatment of human papillomavirus-induced genital warts, actinic keratosis, and superficial basal cell carcinoma.[18,19,20]


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