Introduction

A pyogenic granuloma, also known as a pregnancy tumour when it occurs during pregnancy, is a small, rapidly proliferating, non-cancerous raised growth made up of abnormal blood vessels. Hormonal changes during pregnancy can trigger the development of pyogenic granulomas, particularly on the gums. They often appear as a pink to reddish-purple colour and can rupture and bleed easily.¹.²

Where on the body do they usually appear?

Pyogenic granulomas can appear anywhere on the skin, but they tend to occur more frequently in specific locations. The most common sites include;

• The mouth (oral cavity) - especially the gums (75%), but also the lips, tongue, and inner lining of cheeks
• Face 
• Inner lining of the nose
• Fingers and toes³

Clinical presentation of pyogenic granuloma

A pyogenic granuloma presents as a painless red fleshy nodule/bump that is raised from the skin. They grow quickly and typically vary from a few millimetres to several centimetres in size. The pyogenic granuloma will usually reach its full size within weeks or months and will rarely exceed a diameter of 2.5cm.⁴

The colour ranges from pink (newer) to purple (older).⁴

Bleeding is a common symptom of pyogenic granulomas, particularly as a result of minor trauma.⁴

Who is at risk of developing a pyogenic granuloma?

Pyogenic granuloma can affect individuals of all ages, from children (with an average age of six to ten years) to young adults. ⁵

They are more common in females than in males, largely due to hormonal influences associated with pregnancy (particularly during the second or third trimester), puberty, menopause and the use of oral contraceptives. 

Hormonal influence on PG development in pregnancy

Estrogen’s contribution

During pregnancy, elevated levels of estrogen stimulate the production of vascular endothelial growth factor (VEGF),⁶ a protein in our body that helps the formation of new blood vessels (a process known as angiogenesis). This increase in vascular growth also promotes endothelial cell proliferation, referring to the multiplication of cells, which further contributes to pyogenic granuloma.

Progesterone’s contribution 

In pregnant women, progesterone suppresses the local immune defence

in the gum tissues. This reduction in immune activity prevents an acute inflammatory reaction against dental plaque or local trauma. As a result, even minor trauma or bacterial plaque accumulation can trigger an exaggerated chronic inflammatory response by the gum tissues, leading to an exuberant granulation tissue - an excessive growth of healing tissues rising above the skin,  which is irregular, swollen and bumpy in appearance.⁷

Use of birth control

Hormonal medications can increase the risk of developing a pyogenic granuloma.

Is there a cure for pyogenic granuloma?

Yes, in pregnant women, pyogenic granuloma  usually disappears following childbirth, when hormonal levels return to normal

If persistent, there are several alternative treatment modalities available, including;

• Surgical removalCurettage (scraping of the lesion)
• Laser therapy
• Cryotherapy (freezing of the lesion)
• Topical medications⁸

What can I do to prevent a pyogenic granuloma during pregnancy?

1. Maintain oral and hand hygiene
2. Avoid brushing your teeth too vigorously
3. Get a professional cleaning of teeth by the Dentist to remove excess plaque and calculus from teeth every six months
4. Avoid oral and nasal piercings as they can lead to irritation

FAQs

How common is a pyogenic granuloma during pregnancy?

Pyogenic granuloma occurs in 5% of pregnant women. 

What causes a pyogenic granuloma?

Several factors can contribute to the development of a pyogenic granuloma, including;

1. Poor oral hygiene is causing gum inflammation
2. Overhanging restorations of teeth leading to gum irritation
3. Minor trauma or injury allows microorganisms to infiltrate the site
4. Hormonal fluctuations, especially during pregnancy, puberty, or while taking oral contraceptives
5. Certain medications, including those used to treat HIV, cancer, or as immunosuppressants

Summary

Pyogenic granuloma, also known as the pregnancy tumour,  often occurs due to hormonal fluctuations, particularly increased levels of estrogen and progesterone. For this reason, the appearance of pyogenic granulomas during pregnancy is common. However, they usually resolve following the child's delivery. Brushing your teeth twice daily along with regular dental check-ups and professional cleaning and and avoiding minor injuries can help prevent the occurrence of pyogenic granulomas. If required, treatment options include topical medications, surgical removal, cryotherapy and laser therapy.