Introduction 

A pyogenic granuloma is a condition where a small protruding growth of blood vessels forms on the skin. The name is misleading as pyogenic suggests pus is produced and granuloma means it's a form of immune cells; however, neither of these is true for pyogenic granulomas. While these growths are harmless, treatment can be sought to remove them and reduce their chance of recurring. There are a variety of different treatments that can be given for pyogenic granuloma, including topical, intralesional and surgical treatments. This article will explore the different treatments that can be given to patients with pyogenic granuloma, which fall into these classes. 

Overview of pyogenic granuloma 

What is a pyogenic granuloma?

Pyogenic granuloma involves a growth developing on the skin. This normally occurs on the fingers or face, with the mouth being commonly affected. This can affect the tongue, the gums and the inside of the nose. These growths are made up of small blood vessels known as capillaries and, therefore, are not infectious and cannot be spread between individuals. Pyogenic granuloma is a benign growth, which means it is non-cancerous. The growths it produces are a type of tumour known as a lobular capillary haemangioma. 

What are the symptoms of pyogenic granuloma? 

Pyogenic granuloma appears as lumps extending out of the skin and is a couple of millimetres in size. These are red in colour when the lump initially forms, but they can vary and appear purple and yellow. Initially, these growths appear smooth but over time can harden and seem crusty. Since these lumps contain blood capillaries, they can easily bleed. This repeated bleeding can be a reason why a patient with this condition would seek treatment. Individuals can have one granuloma or multiple in a similar area on the skin, known as satellite lesions.

What are the causes of pyogenic granuloma?

Pyogenic granuloma commonly affects children and young adults, with those aged 6-7 being the most affected age group. It still affects adults, particularly women who are pregnant or taking oral contraceptive medicines. 

There are a range of factors that can lead to a pyogenic granuloma that promote the growth of blood vessels. This can include trauma to the skin, such as an injury or burn. Increased hormone levels during pregnancy or due to oral contraceptives lead to an increase in incidences in this group. Several medications have been reported to increase the chance of developing pyogenic granuloma, including topical retinoids, HIV drugs such as indinavir, cancer treatments such as paclitaxel and immunosuppressive drugs such as etanercept. 

Therapeutic strategies for pyogenic granuloma 

Pyogenic Granuloma tends not to be painful; however, the repeated bleeding can encourage an individual to treat the growth. The lump of blood vessels may be removed by a medical professional in order to confirm that the lump is not the result of skin cancer. This can also normally be confirmed by a medical professional studying their appearance, as they have a distinct look that sometimes is described as a raspberry. There are alternatives to surgical therapies, such as medicines that can be applied or injected into the affected site. 

Topical treatments 

A topical treatment involves a route of administering medicine by applying it to the outer layer of skin. The main benefit of this type of treatment is that it is minimally invasive. The type of cream and the duration of treatment vary between patients and will be advised by a medical professional. This approach is preferential for the young children that pyogenic granuloma tends to affect. 

Imiquimod 5% is a cream that treats several skin conditions, such as warts. This medicine acts by encouraging the immune system to target damaged cells. The imiquimod 5% cream has been reported to produce irritation in the patient. This involves the skin appearing red and painful as a sign of the damaged skin cells being destroyed. 

Timolol 0.5% is a type of gel that can be applied to the surface of the skin to treat pyogenic granulomas. This gel contains a drug that is a class of beta blockers, which can reduce the pyogenic granuloma over a period of weeks. 

Intralesional treatments 

Intralesional treatment is the procedure of injecting steroids into an area of skin affected by a condition. For the treatment of pyogenic granuloma, this would involve using a syringe to insert medicine directly into the growth of blood vessels. The medicine that is normally administered to the site is a corticosteroid. These are drugs that resemble steroid hormones that are produced by the body and have properties that minimise inflammation by suppressing the immune system. This technique is chosen for cases of pyogenic granuloma where an individual has multiple growths. A downside of this technique is that it is a painful procedure that requires local anaesthesia to minimise the discomfort of the patient. On the other hand, the intralesional approach provides medicine directly to the affected site to improve outcomes. Due to the challenges around this technique, corticosteroids have also been used to treat pyogenic granuloma in a topical form. 

Surgical treatments 

A surgical procedure to remove the pyogenic granuloma is the most common method of removing the growth. One advantage of this technique is that the growth can be sent off for further laboratory testing to confirm the condition as a pyogenic granuloma. The disadvantage of a surgical approach is that it is an invasive procedure that is typically disfavoured by patients. 

The procedure involves the patient being administered anaesthesia to reduce the pain. The pyogenic granuloma can be excised or cauterised. Excision means the growth is cut off the skin and the site is sewn back up with stitches, known as sutured. However, reports of growths recurring after treatment have been made from this technique. Cauterising the pyogenic granuloma means scraping off the growth and applying a heated surgical instrument to remove any affected skin tissue. 

There are other surgical approaches that can be used to remove pyogenic granuloma. These include the use of cryotherapy, which involves freezing the pyogenic granuloma till it is removed. Liquid nitrogen is commonly employed to do this, and the procedure is completed over multiple sessions. This technique does mean that the pyogenic granuloma is not viable for pathology testing to confirm the sample. However, this technique is a cheap and simple option which has been shown to reduce the scarring caused by removing a pyogenic granuloma. 

The final surgical approach is laser therapy. The laser uses gases such as carbon dioxide to create a wavelength of light that can impact the top layer of skin. This technique has the benefit of causing low pain levels to the patient, quick healing times and low levels of scarring. 

Natural treatments 

There is also a more natural method of treating pyogenic granuloma, which is only advised for growths that are not growing or bleeding. This involves applying table salt to the site of the pyogenic granuloma repeatedly till the growth is reduced. This technique should be combined with the application of petroleum jelly on the skin near the growth and containing the salt in a plaster. It is advised that if this approach does not work after a while to seek medical treatment. 

Reducing the risk of pyogenic granuloma 

In addition to the range of medical treatments available for pyogenic granuloma, there are also several actions that can be taken to reduce the risk of pyogenic granulomas. These are highly advised to reduce the chance of a pyogenic granuloma recurring in an individual who has previously had one. Considering pyogenic granulomas tend to form around the mouth and in the oral cavity, it is advised to maintain oral health and seek dental treatment if necessary. 

Summary 

Pyogenic granuloma is a condition that produces nodules of blood vessels to grow out of the skin, predominantly around the mouth and on the fingers. The pyogenic granuloma commonly bleeds, prompting patients to seek a cure. There are a range of approaches involving either topical creams, intralesional injections, surgical treatments or natural methods. The approach taken will vary depending on the individual and the advice from a medical professional.