Pyogenic granuloma
- Overview: Benign vascular lesion (lobular capillary hemangioma); misnomer (neither infectious nor a true granuloma).
- Risk Factors:
- Local minor trauma/injury.
- Pregnancy (granuloma gravidarum, gingival lesions via ↑ estrogen/progesterone). c
- Medications: Systemic retinoids (isotretinoin), EGFR inhibitors.
- Clinical Presentation:
- Rapidly enlarging, bright red/violaceous, glistening papule or nodule.
- Extremely friable: Profuse bleeding with minimal manipulation.
- Classic hyperkeratotic collarette of scale at the base.
- Typical sites: Fingers/hands, face, lips, gingival mucosa.
- Diagnosis:
- Primarily clinical.
- Biopsy/Histopathology: Gold standard; mandatory to rule out amelanotic melanoma.
- High-Yield Differentials:
- Amelanotic melanoma: Older pts, lacks hypervascular friability; (+) S100/SOX10 on bx.
- Bacillary angiomatosis: HIV/CD4 < 50, systemic symptoms (fever), Bartonella on Warthin-Starry stain.
- Kaposi sarcoma: HIV/HHV-8, non-friable violaceous plaques/spindle cells.
- Management:
- Standard (First-line): Surgical excision or curettage with electrodessication of the base (prevents recurrence) + histopathology.
- Pregnancy: Observation (spontaneous postpartum regression is typical; excise only for intractable bleeding).
- Pediatrics/Superficial: Topical timolol gel (second-line).
- Complications: Recurrent bleeding, high recurrence rate if base is not completely destroyed/cauterized.