Introduction 

During pregnancy, your body experiences many changes to support a growing baby. The main one is hormonal changes. Oestrogen and progesterone hormones are on the rise to prepare your body for growing a fetus and also to help provide nutrients for the mother. During this term, your body undergoes numerous physical changes. 

If you’ve been noticing purply-red, inflamed lumps on your skin or mouth that may easily bleed, you’re not alone. 1 in 20 women experience this condition, known as pyogenic granuloma (PG), or pregnancy tumours.¹ 

This article will explain how it occurs, its symptoms and how you can manage it. 

What is pyogenic granuloma?

Pyogenic granuloma (PG) is where small, fast-growing lumps that occur due to the rapid growth of small blood vessels known as capillaries. They’re like tiny little growths of blood vessels which rise to the surface of the skin or areas with mucosal tissue, like the mouth.

The term ‘pyogenic’ means it forms pus; however, PG does not contain any pus but rather bleeds when aggravated. ‘Granuloma’ suggests that it is highly inflamed. Consequently, the name PG is not very suited to the condition; it can also be identified as lobular capillary haemangioma, meaning it is a globular cluster of capillaries.¹  

PG occurs due to hormonal changes, irritation, and minor injuries, and it is your body's natural reaction to grow the capillaries in response to these events. Rest assured, it is a benign condition, meaning they're non-cancerous lesions that occur at the site of any trauma. 

Hormonal effects on PG development

When a woman becomes pregnant, it disrupts their hormonal balance. The hormones oestrogen and progesterone rise in the body, building up to PG. 

Oestrogen: This hormone supports the placenta, increasing blood flow and expanding blood vessels to provide nutrients to the baby. This increased blood vessel activity makes tissue prone to overgrowth, which contributes to PG formation.

Progesterone: This hormone acts as an immunosuppressant to stop the body from rejecting the fetus. It reduces acute inflammatory reactions by promoting chronic tissue response. Therefore, any irritants or local trauma to areas like the gum can cause PG to form and progress.²

Contributing factors 

Although the rising levels of hormones increase the risk of PG during pregnancy, there are other factors which contribute to it too:³

• Local trauma or irritation: Minor injuries or aggressive brushing of the teeth can lead to PG due to the irritation
• Existing gum diseases like gingivitis or plaque can lead to PG
• Decreased apoptosis: Apoptosis (cell death) is reduced during pregnancy, therefore slowing down the body's rate to reduce the granuloma size and allowing it to persist and grow
• Growth factors like vascular endothelial growth factors can further stimulate the growth of PG

Symptoms and diagnosis

• Smooth, non-painful, red or purple raised mass
• Rapid growth
• Bleeds easily when touched
• Commonly appear on the gums, tongue, in the mouth area and skin
• Range in sizes from 5 cm in diameter to millimetres
• Commonly develops between the second to eighth months of pregnancy

Your general practitioner can diagnose PG by visual examination, and they can also take tissue biopsies to rule out any other conditions if concerned. Figure 1 shows an AI-generated image of PG. It is important to know that the shapes and sizes can vary from location to location and person to person. 

Figure 1 shows the lobular structure of PG and how it is smooth and tender. Its deep red colour is due to it having a high network of capillaries. This image is AI-generated. 

Managing PG

PG is typically harmless and not life-threatening. It can be easily treated but requires patience. Seek medical advice before applying any ointments to the skin. 

At-home care

• Maintain good oral hygiene by using a soft-bristle toothbrush and brushing in gentle motions
• Saltwater to rinse the mouth to reduce irritation and prevent
• Avoid trauma to the area or harsh chemicals
• One study found that applying a layer of petroleum jelly to the skin around the lesion and then applying table salt directly to the lesion, whilst also bandaging it to have direct salt contact, helped to remove the lesion.⁴ However, you should seek medical advice first

Medical treatments

• Laser therapy
• Cryotherapy using nitrogen
• Surgical removal for large recurrent lesions
• Mild corticosteroids can be topically applied under medical guidance

Summary 

Pyogenic granuloma occurs in pregnancy due to the increased hormonal activity, which increases blood circulation and tissue sensitivity, leading to excessive capillary growth. 

Although most cases of PG resolve after childbirth, there are at-home-care solutions which can help reduce existing lesions and prevent the formation of more. There are also medical treatments for a fast fix. Managing at-home salt rinses and salt presses are recommended, as well as using mild soaps and being gentle around the area. Medical attention is advised if pain or discomfort occurs, as well as excessive bleeding and exponential growth. 

FAQs

Does PG go away after pregnancy?

Rest assured, following childbirth, as your oestrogen and progesterone levels regulate, PG will stop occurring and existing lumps will eventually go down. Know this is only temporary, and with time and mental perseverance, your skin will return to normal. 

Is there a risk of it coming back?

Unfortunately, there is. Statistically, there is a chance of it coming back 15% of the time, but it can be treated by surgical removal and stitching of the wound.