Giant recurrent pyogenic granuloma on the face with satellitosis responsive to systemic steroids

Topical timolol 0.5% as the primary treatment of ophthalmic pyogenic granuloma: A prospective, single-arm study

Purpose:

To study topical timolol (0.5%) as a first-line treatment in ophthalmic pyogenic granuloma (PG) in terms of safety and efficacy.

Methods:

This was a prospective, interventional, single-arm study conducted at a tertiary eye care hospital in central India. Only new cases of PG were counseled to get enrolled in the study. A total of 40 patients were analyzed in the study. Topical timolol eye drop (0.5%) was started in each patient twice daily for 4–6 weeks duration. The patients were divided into five categories according to the percentage reduction in the size of PG as follows: i) 80–100% reduction - excellent responders, ii) 60–80% – good, iii) 40–60% – satisfactory, iv) 20–40% – poor, and v) <20% – very poor/nonresponder. After 6 months of starting treatment final evaluation was done.

Results:

The mean age of the patients was 23.5 ± 13.3 years. Etiology of the disease included chalazion (n = 11, 27.5%), trauma (n = 2, 5%), surgery (n = 7, 17.5%), foreign body (n = 2, 5%), and idiopathic (n = 18, 45%). An excellent response was achieved in 31 (77.5%) patients. Twenty-seven (67.5%) patients had complete resolution of lesions within 6 weeks. Recurrence of the lesion was not noticed in any patients.

Conclusion:

Timolol 0.5% in topical form is a good treatment option for ophthalmic PG in all age groups. The treatment has no adverse effects when given to suitable individuals for a limited period.

[Pyogenic granuloma with satellitosis]

A 16-year-old female developed a satellite-like recurrence of a pyogenic granuloma on her thorax 2 weeks after complete excision. Treatment with a pulsed dye laser led to a complete resolution. BRAF and RAS mutations detected in the pyogenic granuloma are considered major driver mutations. Whether these findings are also of importance for the etiopathogenesis of satellitosis is unknown. In our patient, no BRAF or NRAS mutation could be detected.

Alternative Therapeutic Approach in the Treatment of Oral Pyogenic Granuloma

Pyogenic granulomas (PGs) in the oral cavity present as an inflammatory hyperplasia usually caused by trauma, hormonal imbalance, chronic irritation, or as the response to a wide variety of drugs. PGs with atypical presentation and behavior may clinically mimic malignant tumors. Thus, histological examination is required to rule out cancer development. Lesions in the oral cavity have been described to be either an isolated entity or present in multiple forms and with multiple recurrences. Conservative surgical excision is the standard choice of treatment in almost every scenario. However, the severity of the lesions and the affected sites often challenge surgical treatment. In this report, we describe the clinical scenario of a recurrent PG, where surgical excision of the lesion was questioned. As an alternative, we describe a noninvasive approach with lesional steroid injections.

Pre-operative effects of the administration of systemic corticosteroids combined with antibiotics on a lobular capillary hemangioma in the nasal cavity

Lobular capillary hemangiomas (LCHs), also known as pyogenic granulomas, are benign, rapidly growing hemorrhagic lesions that usually develop in the oral or nasal cavities. In adults, LCHs occur in <5% of all pregnant women. A 30-year-old woman presented with a 4-month history of right-sided nasal obstruction and recurrent epistaxis 2 months post-partum. A fragile, pink-red lobulated tumor existed in the anterior portion of the right inferior turbinate; the biopsy revealed a LCH. Although the patient declined surgery using an external approach, treatment with systemic corticosteroids combined with antibiotics resulted in tumor regression and an endoscopic en bloc resection was possible. No recurrence has been noted to date (>1 year after surgery). Pre-operative treatment with systemic corticosteroids combined with antibiotics may be useful to induce tumor regression and to excise the lesion completely with an endoscopic approach.

[Recurrent pyogenic granuloma]

The appearance of multiple satellite lesions is a rare complication of the treatment of a primary pyogenic granuloma lesion. We report 5 cases of recurrent pyogenic granuloma in patients aged between 4 and 31 years. The lesions resolved spontaneously after 1 to 9 months. Although the diagnosis and treatment of recurrent pyogenic granuloma can be problematic, this condition is benign and frequently self-limiting.

Treatment options for cutaneous pyogenic granulomas: a review

Pyogenic granuloma (PG) is a common benign vascular proliferation that commonly occurs on the skin. Various treatment options exist in the literature with no clear consensus. Our objective was to review the literature associated with PGs and their management, and based on recurrence rates, suggest management options. A retrospective literature review examining the treatment of cutaneous PG and their associated recurrence rates was conducted. A total of 34 manuscripts were included in our review; with 1162 PGs managed using 19 different treatment modalities with 53 recurrences observed. Among the surgical management options, surgical excision offers the lowest overall recurrence rates (2.94%). Of the medical treatments, cryotherapy offered the lowest overall recurrence rate (1.62%). We concluded that surgical excision and primary closure should be the treatment of choice for small cutaneous PGs in non-cosmetically sensitive areas; however if non-surgical management is undertaken, cauterization with silver nitrate should be the first line treatment. When comparing recurrence rates of surgical excision vs. cauterization, we found no statistical difference between the two (p-value 0.426).

Pyogenic granuloma of the foot with satellitosis: a role for conservative management

BACKGROUND

Pyogenic granuloma (PG) with satellitosis is a rare phenomenon that typically occurs in children and teenagers. It can be seen after excision or trauma to the original lesion.

OBJECTIVE

The aim is to review an atypical case of PG with satellitosis and to highlight a conservative approach to management.

METHODS

This article includes a case report of a 48-year-old woman developing PG with satellitosis in her right foot and includes a review of the literature.

RESULTS

There are few cases of PG with satellitosis in the literature. Our patient differs from most given her age and the location of the lesions. She was managed differently with a conservative observational approach, and, over time, her symptoms abated.

CONCLUSION

PG with satellitosis can occur in varying patient populations with varying presentations. Although several treatment options exist, managing patients conservatively should be considered an approach to management. Early investigations should be conducted to rule out more sinister items in the differential diagnosis.

Giant pyogenic granuloma of the thigh: a case report

Introduction

Pyogenic granuloma or lobular capillary hemangioma remains an etiopathological enigma, with trauma, inflammatory and infectious agents being the commonest suspected causative agents. These lesions affect mucous membranes of the upper aero-digestive tract, and skin. HIV patients diagnosed with pyogenic granuloma present with multiple lesions, caused by Bartonella spp.

Case presentation

A 28-year-old woman presented with a solitary large tumor on a skin graft donor site on her left thigh. On excision and histological examination the tumor was found to be a lobular capillary hemangioma (pyogenic granuloma). Further investigation in search of a possible explanation for this unusual presentation revealed HIV infection as the underlying cause.

Conclusion

This report underscores the fact that the full spectrum of presentation of HIV infection is still unknown. Unusual or unexpected presentations should arouse suspicion of underlying immunosuppression, especially in HIV endemic areas.

Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial

BACKGROUND

Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes. Many different treatments have been used, with variable success rates.

OBJECTIVES

To evaluate and compare the effects of cryotherapy and curettage in the treatment of pyogenic granuloma.

METHODS

Eighty-nine patients with pyogenic granuloma were randomized to receive cryotherapy with liquid nitrogen or curettage and electrodesiccation. Forty patients in the cryotherapy group and 36 patients in the curettage group completed the study period.

RESULTS

Among the patients who completed the study, treatment resulted in complete resolution of all lesions after one to three sessions (mean 1.42) in the cryotherapy group and after one to two sessions (mean 1.03) in the curettage group. The difference between the two groups was statistically significant (P < 0.001). Twenty-three patients (57.5%) in the cryotherapy group and 25 patients (69%) in the curettage group had no scar or pigmentation abnormality. Except for cosmetic problems, no other side-effect or complication was recorded in the study.

CONCLUSIONS

This study showed that both cryotherapy and curettage are safe and effective. Curettage had the advantage of fewer treatment sessions required to achieve resolution and better cosmetic results. We suggest that curettage could be the first-line treatment for pyogenic granuloma.