Skin Disorders Guide

Diagnostic Hallmarks

1. Distribution: face, hands, feet, and shoulders
2. Rapid growth
3. Occurrence in children, teenagers, and pregnant women

Clinical Presentation

Pyogenic granulomas are smooth-surfaced, red papules 5 to 15 mm in diameter. Most. lesions are dome shaped, but some are pedunculated. They may occur anywhere on the body but are most commonly seen over the shoulders and face. Lesions are occasionally seen on the hands and feet. Most pyogenic granulomas are found in children aged 5 to 15 years, but pregnant women are also at risk. They are asymptomat.ic except for rather easy bleeding following trauma. Previously traumatized lesions will have a partially crusted surface.

Course and Prognosis

Pyogenic granulomas first. appear as pinhead-sized papules, but t.hey grow rapidly within weeks to their final size. Left untreated, pyogenic granulomas eventually undergo spon­taneous resolution. They have no malignant potential, but their rapid growth and occasional dusky color sometimes simulate the appearance of melanoma. Such lesions should obviously be biopsied. Recurrence after treatment (occasionally with the presence of new satellite lesions) is not uncommon.

Pathogenesis

The cause of pyogenic granulomas is unknown. In spite of their name they are not granulomas, and they are not caused by infections. Histologically, they appear to be true hemangiomas. Their occurrence in late childhood and in pregnant women suggests that hormonal factors may play a role in their development.. Satellite recurrence in some patients after removal seems to indicate that a field defect involving the surrounding vascular bed may be present.

Therapy

Lesions may be removed by elliptical excision or laser ablation,or after shave removal, the base may be destroyed with electrosurgy. Cryotherapy is sometimes successful, especially if it is repeated on several occasions. Recurrences are frequently observed if the original therapy was insufficiently aggressive.