Granuloma gravidarum

Refers to a pyogenic granuloma that occurs during pregnancy.

It is especially seen on the gingiva and occurs in approximately 2-5% of pregnancies.

It occurs usually in the second or third trimester of pregnancy.

It is believed that estrogen and progesterone elevations during pregnancy enhance expression of angiogenic factors and lead to formation of pyogenic granuloma.

Granuloma formation may also be an exaggerated response to trauma, local irritation, or poor oral hygiene related to hormonal factors.

Histologically findings are of lobular proliferation of capillaries within a network of fibrovascular tissue and is accompanied by a mixture of inflammatory cells.

In lesions that undergo regression fibrosis may be present.

Lesions are seen primarily on the gingival mucosa, followed by the lips, tongue, and buccal mucosa.

Lesions more common on the maxillary gingiva than the mandibular gingiva.

involvement of the anterior areas more than posterior areas of the mouth and and facial aspects of the gingiva.

May also involve cutaneous lesions.

Nasal lesions are rare.

Typical presentation are as a painless, soft, papule or nodule, or sessile or pedunculated polyp with a smooth, glistening, erosive, or friable surface.

The vascularity affects the color of the lesion and it may be red to pink.

The lesions grow rapidly and bleed easily due to its vascular nature.

Diagnosis is a clinical one and is considered when any mass develops in the oral cavity, nasal cavity, ear or skin of a pregnant female.

Diagnosis is enhanced if the lesion bleeds and is growing quickly.

Dermoscopy increases diagnostic accuracy by revealing redhomogeneous areas and white scaly hyperplastic epithelium.

Biopsy is necessary if the diagnosis is doubtful.

Complications include bleeding, ulceration and secondary infection.

The lesion can be unsightly if occurs on the face.

The lesion may resolve after childbirth.

Overall the prognosis for this lesion is good.

Small and asymptomatic lesions require observation only.

Active management for lesions required that are severe, associated with hemorrhage, ulceration, interfere with vital structures and caused significant disfigurement.

Complete surgical excision is the treatment of choice.

Alternative treatments include electrodesiccation, curettage, laser surgery, liquid nitrogen cryotherapy, sclerotherapy, topical silver nitrate, and topical imiquimod.

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