Pyogenic granuloma


A common benign vascular proliferation.

It is not related to infection or to a granulomatous disease.

Lobular capillary hemangioma is a more acceptable terminology.

It presents typically as a solitary papule appearing subacute over weeks.

Bleeds easily.

Occurs, and individuals of all ages, but most frequently develops prepubertal children and pregnant women.

Bimodal distribution children with peaks at one year at age 11-12 years.

More common in young boys than young girls.

Most common area of involvement is the head and neck.

Etiology remains unknown but and he be related to minor trauma, chronic wounds, viral infection, and exposure to female hormones.

Associated with increased VEGF and beta-FGF.

Not associated with malignant potential.

May spontaneously regress.

Treatment includes cryotherapy, curettage, shave excision, topical imiquimod claim and counter lethal corticosteroids and surgical excision.

Recurrence rates are low.

A benign vascular tumor with rapid growth and a friable surface that most commonly appears spontaneously on mucosal and cutaneous surfaces.

The lesions are clusters of hyperplastic capillaries separated into lobules by fibromyxoid stroma.

Termed lobular capillary hemangioma.

They are neither pyogenic nor granulomatous.

Typically presents as a painless mass with recurrent bleeding on the head, trunk, or limbs.

Can present at any age but are most common in children and young adults.

Rarely spontaneously resolve.

Often complicated by repeated episodes of bleeding.

Surgical treatment is the pref2242ed course of management in most cases.

About 86% occur on cutaneous surfaces and are most common in children and young adults, with a slight male predominance.

They develop less commonly on mucosal surfaces, a presentation that may be twice as common in the female population.

Most common locations of mucosal lesions are the oral mucosa and the nose, with conjunctival, cervical, and vaginal lesions each accounting for approximately 5% of mucosal lesions.

Occasionally, present intravascularly, subcutaneously, and rarely in the gastrointestinal tract.

Endothelial cells in these lesions express higher levels of the proteins CD34, ICAM-1, and VCAM-1 than normal tissue, demonstrating increased vascular density and angiogenesis.

Risk factors: trauma, chronic irritation, capillary malformations, and laser treatment of capillary malformations.

Associated with certain medications: isotretinoin, antineoplastic agents such as capecitabine, and the BRAF inhibitors vemurafenib and encorafenib.

Appears as a solitary erythematous nodule that is smooth, soft, occasionally crusted.

Lesions are commonly surrounded by a thin, white collar, and appear rapidly, within days to weeks.

Usually of spontaneous presentation with no precipitating exposure or symptoms.

An estimated 7% to 14% of patients have a history of minor trauma or chronic irritation at the site of the lesion.

The diagnosis is mainly clinical with findings of an erythematous papule that bleeds easily and that has arisen within days to weeks.

Up to 85% of cutaneous pyogenic granulomas are surrounded by a white collarette, a rim of loosened keratin.

Prognosis of lesions varies with underlying factors.

Without treatment, pyogenic granulomas may often persist throughout life.

Lesions arising after injury or chronic irritation are likely to resolve upon removal of the irritating stimulus.

With treatment, recurrence rates average 4% to 5% across all treatment types.

Most common treatment is surgical excision with linear closure.

Surgery allows for histopathologic analysis definitive diagnosis.

Surgical excision has a recurrence rate of approximately 3% to 4%.

Curettage, shave excision, and cautery have been shown to have a combined recurrence rate of approximately 10%.

Cryotherapy with liquid nitrogen is associated with a low recurrence rate of 1.62%, however, up to one-fourth of patients treated in this way require a second treatment.

Other nonsurgical treatments include carbon dioxide laser ablation and pulsed-dye laser therapy, which had recurrence rates of 4.85% and 4.35%, respectively.

Topical imiquimod cream, 5%, has been shown to greatly reduce the size and color of lesions.

The topical β-blocking agent timolol maleate ophthalmic solution, 0.5%, has been shown to reduce bleeding and tumor size.

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