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Pyogenic granuloma

The Toronto Dermatology Centre is one of the best places in Canada to manage your skin lesions such as the pyogenic granuloma. Our staff of outstanding dermatologists offer both a comprehensive assessment and diagnosis of your skin lesion, and also discuss all the treatment options.

A pyogenic granuloma is a relatively common benign vascular lesion that grows quickly over a few weeks, and affects skin (particularly head, neck & digits) and mucosae. The name is a misnomer, and the cause is unclear; it has also been referred to as “proud flesh”.

It is more common in children, young adults and in pregnancy (usually 2nd-3rd trimester), and presents as a shiny red papule that is easily prone to bleeding. Discomfort and bleeding as well as cosmesis often warrant treatment.

Pyogenic granulomas have also been associated with trauma, and with oral retinoids (uncommonly topical retinoids), protease-inhibitors (especially indinavir), and the chemotherapeutic capecitabine.

Clinical examination reveals a bright red pedunculated papule that is usually several millimetres in size. It is friable and bleeds easily, and so erosion and crusting may be evident.

The gingiva, lips & face, fingers and around the nails, and forearms are common locations for involvement, although any skin surface can be affected. In pregnancy, PGs or “granuloma gravidarum” typically affect intraoral or perioral mucosal surfaces.

The possible causes include medications, hormonal influence, trauma, bacterial or viral infections, and angiogenic factors. Bloodwork and imaging are unnecessary. Management involves removing any possible inciting factors such as medications and trauma which often results in lesions involuting.

Pyogenic granulomas can be treated under local anesthesia by shave excision, electrodessication and curettage, liquid nitrogen or laser surgery.

Here is a selection of scientific articles by our renowned dermatologists Dr. Benjamin Barankin and Dr. Anatoli Freiman as they pertain to pyogenic granuloma.

Pyogenic Granuloma 1
  Pyogenic granuloma 2

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