Pyogenic Granuloma

What a pyogenic granuloma is

A pyogenic granuloma is an overgrowth of capillaries, the smallest blood vessels, arranged in lobules. That is why dermatologists now prefer the name lobular capillary hemangioma. It is a reactive growth: the body overdoes the formation of new blood vessels while healing a small injury or in response to hormones or drugs.

The old name is misleading on both counts. "Pyogenic" suggests pus or bacterial infection, and "granuloma" suggests a specific type of inflammation. Neither is present.

Pyogenic granulomas are benign. They do not turn into cancer.

What it looks like

• a smooth, shiny, bright red to dark red bump
• sometimes a raw, moist or crusted surface
• usually 2 mm to 1 cm, rarely larger
• often on a narrow stalk, with a collar of skin around the base
• grows rapidly over days to weeks, then stops
• usually painless
• bleeds very easily, sometimes heavily, after minor contact

Where it appears

• Fingers and hands, often after a cut, splinter or around a nail
• Face, scalp, lips and upper body
• Gums, especially in pregnancy (sometimes called a pregnancy tumor or granuloma gravidarum)
• Around ingrown toenails, as a red overgrowth at the nail fold. See ingrown toenail.

Causes and risk factors

• Minor skin injury: cuts, scratches, insect bites, piercing or picking. Many people recall no injury.
• Pregnancy: hormones encourage blood vessel growth. Oral lesions on the gums are common, often in the second and third trimesters.
• Medicines: oral retinoids such as isotretinoin and acitretin, some cancer drugs (including EGFR inhibitors), certain HIV medicines and oral contraceptives can trigger them, often around the nails.
• Age: most common in children and young adults, though any age can be affected.
• Port-wine stains and other vascular birthmarks can develop pyogenic granulomas within them.

How it differs from look-alikes

Because a few skin cancers can mimic pyogenic granuloma, the removed tissue is usually sent for examination under a microscope.

Diagnosis

Most pyogenic granulomas are diagnosed by their appearance and history of rapid growth. A dermatologist may examine it with a dermatoscope, a lighted magnifier. The diagnosis is confirmed by histology (microscope examination) after removal, which is especially important for adults, lesions with any pigment, or those in unusual places.

Treatment

Treatment is usually recommended because of bleeding and to confirm the diagnosis.

• Shave excision with cautery (curettage and electrocautery): the most common treatment. The bump is shaved off at its base under local anesthetic, and the base is cauterized to stop bleeding and reduce regrowth. It takes a few minutes.
• Surgical excision: cutting out the whole lesion with stitches. It has the lowest chance of recurrence but leaves a linear scar.
• Laser treatment: pulsed-dye laser works for small lesions, especially in children and on the face.
• Cryotherapy: freezing, used for small lesions.
• Topical treatments: timolol gel, a beta-blocker, can shrink small lesions in children. Silver nitrate sticks are sometimes used for small lesions or nail-fold granulomas.

During pregnancy

Gum and skin lesions in pregnancy often shrink or disappear within weeks to months after delivery. If they bleed a lot or interfere with eating, they can be removed safely during pregnancy. Good oral hygiene and dental cleaning help prevent gum lesions.

Medicine-related lesions

These often improve if the medicine can be reduced or stopped. If not, they can be treated locally.

Recurrence

Pyogenic granulomas come back in roughly 1 in 10 to 1 in 7 people, more often after shave removal than full excision, and particularly on the trunk of young adults. Sometimes several small "satellite" lesions appear around the original site after treatment. These are also benign and can be treated the same way.

How to stop a pyogenic granuloma from bleeding

• Press firmly with clean gauze or a cloth, without lifting to check, for 10 to 15 minutes.
• Keep the area raised if it is on a hand or foot.
• Cover it with a non-stick dressing to protect it from knocks until you can have it removed.
• Seek urgent care if bleeding does not stop after 20 minutes of pressure.

Frequently asked questions

Is a pyogenic granuloma cancer?

No. A pyogenic granuloma is a benign growth of blood vessels and does not become cancer. However, a few skin cancers, especially amelanotic melanoma, can look similar, so removed lesions are usually examined under a microscope to confirm the diagnosis.

Will a pyogenic granuloma go away on its own?

Rarely, unless it appeared in pregnancy or was triggered by a medicine. Pregnancy-related lesions often shrink after birth, and medicine-related ones may improve if the drug is stopped. Most others persist and keep bleeding until removed.

Why does a pyogenic granuloma bleed so much?

It is made almost entirely of tiny, fragile blood vessels close to the surface, with only a thin covering of skin. Even a light knock can break the surface and cause surprisingly heavy bleeding.

What causes a pyogenic granuloma on the finger?

Fingers are a common site because they are frequently cut, scratched, pricked or affected by nail injuries. The body overreacts while healing, producing a cluster of new blood vessels. Some medicines, such as isotretinoin, also trigger them around the nails.

Can I remove a pyogenic granuloma at home?

No. Trying to cut, tie off or burn it at home risks heavy bleeding, infection and scarring, and the lesion often comes back. Removal by a doctor stops bleeding properly and allows the tissue to be checked under a microscope.