Pyogenic Granuloma: Neither Pyogenic nor a Granuloma

I prefer the name proud flesh for this odd skin lesion, which despite its most common name pyogenic granuloma is neither due to infection as implied by the pyogenic part of the name nor a granuloma histologically.  The more proper name of “lobular capillary hemangioma“ is rarely used and hard to remember, and proud flesh describes the prominent and startlingly rapid growth of this fairly common lesion. Pyogenic granulomas seem to just start for no good reason and grow rapidly.  They are typically strawberry red colored, smooth surfaced, bleed easily, sometimes hurt and tend to be very annoying. They often occur in the area of a cut or scratch, but sometimes seem to erupt without any preceding injury.

Silver Nitrate Sticks

Fortunately pyogenic granuloma is usually easy to treat and is almost never malignant or life threatening.  My preferred treatment for pyogenic granuloma is the application of silver nitrate by using silver nitrate sticks.  This is so easy to do that I usually apply the first atreatment in the office and have patients repeat the application every 2-3 days at home until the lesion regresses and resolves.  Interestingly silver nitrate, the chemical used in photographic paper, is very light sensitive, and the sticks need to be stored in a dark container. Alternative treatments include electro-cautery, laser therapy and excision with either shave biopsy or full-thickness skin excision. The problem with these is the likelihood or recurrence with shave biopsy and the scar left with excision.

The cause of pyogenic granuloma is not known. Pyogenic granuloma is more common in pregnancy, and I was prompted to write this post after seeing a woman in the office today who had a lesion begin in the last weeks of pregnancy and continue to grow, bleed and hurt until I saw her today 6 days post-partum.  I expect her to get prompt improvement with the silver nitrate therapy started today. Her lesion was on her arm, but the more common location of pregnancy related pyogenic granuloma is in the mouth, often on the gums.

Another common place for pyogenic granuloma is on the umbilical stump of newborns.  This type of pyogenic granuloma almost always resolves nicely with silver nitrate application.
The bleeding and rapid growth of these can be quite frightening to parents, but the infants seem oblivious to the lesion as well as to the treatment.   Other common areas for pyogenic granuloma to occur are on the hands, arms and torso.

Although these can be annoying, uncomfortable and frightening until you get a diagnosis, pyogenic granuloma is essentially never serious and usually resolve nicely after diagnosis and treatment.