Treatment Of Pyogenic Granuloma Research Articles

Correction to: High power diode laser in the treatment of pyogenic granuloma in young patients

Correction to: High power diode laser in the treatment of pyogenic granuloma in young patients

Rare presentation of pyogenic granuloma: a case report

The pyogenic granuloma (PG) Also called lobular capillary hemangioma, is a prevalent tumorlike growth and vascular hyperplasia of the skin and mucous membranes. The condition arises in reaction to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. It can manifest at any age. The most common site is gingiva, extra gingival occurrence of PG is rare, although have been reported. Management of PG Depends on the area, size of lesion and patient preferences. However, the conservative surgical excision usually the curative treatment of PG. Alternative treatment modalities that have been employed include laser therapy, corticosteroid injections, cryosurgery, and sclerotherapy. In the case report has described an extra gingival PG which occurred on the lower lip in a 19-year-old female patient. The clinical and histopathological assessments confirmed the diagnosis of PG.

Superficial Radiotherapy (SRT-100) as an Effective Noninvasive Treatment for Pyogenic Granuloma: Case Report and Literature Review

Introduction. Pyogenic granuloma (PG) is a common condition characterized by the appearance of a small raspberry-like vascular growth that may appear on any part of the skin. PG usually occurs secondary to acute or chronic trauma. The primary treatment for PG is noninvasive therapy. In refractory cases, surgical resection is an alternative. Superficial radiation therapy system (SRT-100) is a new technology that uses low-energy radiotherapy to treat nonmelanoma skin cancers. SRT may also be used for the treatment of patients with PG who are unwilling to undergo surgery. Case Presentation. A 27-year-old woman presented with a recurrent neoplasm in the middle finger of the left hand after surgical resection. She refused to undergo reoperation or other aggressive options such as electrocautery or liquid nitrogen cryotherapy, so we prescribed only superficial radiotherapy (SRT-100) alone, with a total dose of 14 Gy in four fractions. Conclusion. The neoplasm gradually flattened after treatment with 14 Gy in four fractions and disappeared completely 3 months after completion of treatment.

Problems in the treatment of pyogenic granulomas in children (a literature review)

Introduction. Pyogenic granuloma (PG) is an acquired benign vascular tumor of the skin or mucosa, often solitary, 1.0±0.5 cm in size. Despite various methods for PG care, there is a large number of unsatisfactory outcomes. In this regard, the problem of PG treatment is still actual and requires optimization of curative options to improve clinical and aesthetic outcomes.Purpose. To study current problems and to define prospects for PG management in children after reviewing current literature for the period 2005–2022.Material and methods. A literature search was made in domestic and foreign databases – FEML (Federal Electronic Medical Library), eLIBRARY, PubMed for the period 2005–2022. Key words used for the search: pyogenic granuloma; lobular capillary hemangioma, laser radiation. 1224 sources of literature were studied, 59 works were included in the review.Results. Though various techniques of PG removal are used, unsatisfactory outcomes are seen in 40% of patients; out of them up to 16% are recurrences; hypertrophic cicatricial deformities of the skin at incision areas are met in 34%.Conclusion. Future researches are expected to develop optimal ways for removing PG in children using modern laser medical techniques adapted for this pathology so as to achieve a significant improvement in clinical and aesthetic outcomes in treating this vascular pathology in children.

DS18 Efficacy of intralesional sodium tetradecyl sulfate in pyogenic granuloma

Abstract Data on sclerotherapy in pyogenic granuloma (PG) are sparse and limited to a few case reports and series (Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol 2019; 58:642–8). We present a series of 18 patients with PG treated with intralesional sodium tetradecyl sulphate (STDS). The aim of this study was to evaluate the efficacy, safety and recurrence rates of STDS sclerotherapy in the treatment of PG. Eighteen patients with PG (based on history and clinical features) of any age consenting to be part of the trial were included. Intralesional STDS 1% was injected slowly using an insulin syringe until the lesion blanched, and a maximum of 1 mL was used in one sitting. Patients were followed-up weekly; if the lesion did not show complete resolution, repeat injections were given up to a maximum of three sittings. A final assessment for relapses was done at 4, 8 and 16 weeks after treatment completion. All patients had complete clearance (100%) of the lesions with STDS 1% in one or two sittings. Noted side-effects included pain (n = 6), oedema (n = 4), purpuric staining (n = 2), paraesthesia (n = 1), ulceration (n = 2), necrosis (n = 2) and urticarial rash (n = 1). All side-effects resolved completely; two patients had to take analgesics and oral antibiotics. No bleeding episodes occurred in any patient after the first sitting. Further, none has shown recurrence over a follow-up period of 4 months. Eight patients developed mild atrophic scars as post-treatment sequelae. Sclerotherapy is a simple procedure; however, surprisingly, the literature on its use in PG, a very suitable indication for sclerotherapy by virtue of the pathology involved, is sparse. In this study, STDS successfully cleared the lesions in all patients without major complications or recurrence.

Treatment of Extra-gingival Pyogenic Granuloma (<i>Athara ratthathontham</i>) in Siddha – A Case Report

The present case report was a 36-year female with lesion on the right side of inner lower lip and diagnosed as pyogenic granuloma occurring at an unusual site. The presently available treatment for pyogenic granuloma is surgical excision which might delay the wound healing due to complications such as intraoperative bleeding and post operative infection. Other treatment modalities such as cryosurgery, CO2 and Nd:YAG lasers, flash lamp pulsed dye lasers, surgical ablation, and radiation may not be affordable for many patients. In our present study, the Siddha para-surgical therapy chuttigai (cauterization) was performed and the case was followed up for 30 days. The intervention was found to be as a simple, inexpensive therapy effective in treating small superficial pedunculated vascular lesions with no blood loss or no need of hospitalization.

Efficacy of available treatments for periungual and subungual pyogenic granulomas: A systematic review

Efficacy of available treatments for periungual and subungual pyogenic granulomas: A systematic review

High power diode laser in the treatment of pyogenic granuloma in young patients

High power diode laser in the treatment of pyogenic granuloma in young patients

Sclerotherapy in Pyogenic Granuloma: An Open Uncontrolled Trial

Objectives: Pyogenic granuloma (PG) is a common, benign lesion of vascular origin. It may rapidly grow in response to an unknown stimulus that triggers endothelial proliferation. The treatment of PG using sclerosing agents is a novel approach to overcome drawbacks associated with other procedures. The crucial purpose of this study is to evaluate the efficacy and safety of detergent sclerosant, sodium tetradecyl sulphate (STS) in the management of PG. Materials and Methods: A total of 18 patients with PG, attending dermatology venereology and leprosy (DVL) outpatient department (OPD) were treated with sclerotherapy after obtaining written and informed consent. STS solution (3%, 30 mg/mL) was injected with insulin syringe slowly into the lesion until the lesion blanched up to maximum amount of 0.3 mL. Injection was repeated every week until resolution or up to a maximum of 4 doses. Follow-up evaluation was performed monthly, up to 3 months. Results: In our study, complete resolution was seen in all the patients. No complication occurred after injection. All the patients were followed up for 3 months and none of the lesions recurred over this duration. Conclusion: Sclerotherapy is effective and safe in the treatment of PG without any recurrence. This approach may become a first-line therapy option for PG, especially in cases of recurrent PG associated with bleeding, and in lesions over surgically inaccessible areas.

Comparison of the Efficacy of Combined Silver Nitrate Coagulation and Shave Excision With Surgical Excision and Linear Closure in the Treatment of Pyogenic Granuloma.

Pyogenic granuloma (PG) is a common benign vascular neoplasia. Optimal treatment should have an aesthetically pleasant scar and a low recurrence rate. No treatment method that is fully effective in solving these has been demonstrated. Silver nitrate cauterization is another method for the management of PG lesions. The effects of silver nitrate on the treatment of PG have not been sufficiently investigated and should be investigated with objective data and a controlled study. The prospective clinical trial was designed to compare silver nitrate cauterization with surgical excision treatment. Procedure times and procedure costs, comfort and satisfaction scales, recurrences, the Patient and Observer Scar Assessment Score, and the Vancouver Scar Scale were compared to evaluate treatments. Silver nitrate treatment had lower procedure times, costs, and better satisfaction and comfort scale scores. The scar assessment scores were better for the silver nitrate treatment. The patients in both groups were successfully treated and no recurrence was seen. Silver nitrate cauterization is low-cost, fast, safe, reliable, and effective with good aesthetic results for the treatment of PG lesions. This study shows that silver nitrate cauterization is a good alternative to surgical excision in the management of PG.

Pyogenic Granuloma Treated with Topical Timolol: A Case Series

Pyogenic Granulomas (PGs) are benign vascular tumours primarily treated with surgical procedures. Recently, topical Timolol, a beta-adrenergic receptor antagonist, has been used for the treatment of PG due to its vasoconstrictive, anti-angiogenic, and wound healing properties. Herein, the authors presented a case series of 12 patients (10 males and two females) with red papules and nodules that spontaneously bleed. The age of the patients ranged from 7-51 years, and the duration of lesions ranged from one week to nine months. The lesions were located on the face, neck, hand, and mucosa. All patients were treated with topical Timolol maleate 0.5% drops twice daily for four weeks and followed-up weekly for four weeks. The treatment efficacy was evaluated based on complete response, partial response, or no response. Changes in colour, size, bleeding tendency, and adverse events were also assessed. Two patients showed complete resolution, while the bleeding tendency improved in the other patients. No side effects were encountered, except in one patient where the lesion increased in size and became secondarily infected. Thus, topical timolol appeared to provide symptomatic improvement by reducing bleeding and lesion size without any side effects. It can be considered as an alternative therapeutic option for small, uncomplicated classical PG.

Diode laser versus sclerotherapy: bloodless approaches in the treatment of oral pyogenic granuloma (randomised controlled clinical trial)

Oral pyogenic granuloma (PG) is traditionally treated by surgical excision which is associated with bleeding, pain and a high rate of recurrence. Our research aimed to clinically assess the effectiveness of diode laser versus sclerotherapy, as bloodless approach, in the treatment of oral PG. We randomly divided 20 patients with oral PG into two groups, with those in the test group being managed via diode laser application and those in the control group via injections of ethanolamine oleate as a sclerosing agent. All patients were evaluated intraoperatively for bleeding severity and postoperatively for pain. The quality of healing was also assessed using Landry healing index after the 1st, 2nd and 4th weeks. Additionally, the patients were recalled after 3, 6 and 9 months from the end of treatment for recurrence evaluation. Our results revealed that intraoperative bleeding did not differ significantly between both groups while postoperative pain decreased significantly in the sclerotherapy group compared to the laser group. For different intervals, the sclerotherapy group had a higher healing quality index than the laser group, although the difference was not statistically significant. However, recurrence occurred in the laser group, there were no cases of recurrence in the sclerotherapy group in all intervals. In conclusion, diode laser treatment of PG is a reliable, less invasive, and sensitive procedure that requires an experienced operator and specialised equipment. However, ethanolamine oleate sclerotherapy is an inexpensive, simple technique besides being less prone to recurrence problems, especially when treatment duration is not a concern.

Effectiveness and safety of 0.5% timolol solution in the treatment of pyogenic granuloma: A randomized, double-blind and placebo-controlled study.

Introduction Pyogenic granulomas are benign vascular lesions of the skin and mucosa which are often a source of concern because of their recurrent bleeding even with minimal trauma. Current treatment for pyogenic granuloma is ablative; no medical therapy is standardized to date. Timolol, due to its vasoconstrictive effect, vascular growth factor inhibition and apoptosis promotion properties, is a potential therapeutic option. Objectives: To assess the effectiveness and safety of topical timolol in the treatment of pyogenic granulomas. Methods A two-centre, double-blind and placebo-controlled trial (Registration CTRI/2019/04/018581) was conducted. Patients of either sex were recruited with pyogenic granuloma lesions of less than eight weeks duration. Topical treatment with 0.5% timolol or matching glycerin placebo was continued for six weeks. Changes in color, size, bleeding tendency, physicians' and patients' global assessments and adverse events were assessed. Results Forty subjects were randomized between the two groups which were comparable in age, sex, duration of illness and baseline lesion size.Significant improvement was noted with timolol, with color change from first follow-up onwards and lesion size reduction from second follow-up onward. Patients' assessment of bleeding tendency also showed imrovement from the second visit onward. Between-group comparison showed significant difference with respect to percentage reduction in size (timolol 40.9%, placebo 3.4%; P = 0.002). Rescue treatment (electrosurgery) was required in five patients on placebo and in one in the timolol group (P = 0.182). Complete resolution occurred in 2 (10%) patients with timolol and in no patients on placebo (P = 0.231). Limitations: We observed effects of treatment for only six weeks. Conclusion Topical timolol may be a treatment option for early pyogenic granulomas but complete resolution is unlikely in six weeks. Studies of longer duration are required to assess resolution and recurrence rates.

Establishing the efficacy and safety of the novel use of common salt for the treatment of pyogenic granuloma

Recurrent bleeding episodes are often a cause of significant anxiety in patients with pyogenic granuloma (PG). The idea of using common salt for the treatment of PG arose from the need for a relatively safe and effective treatment because of the recurrent nature of the lesion. A prospective open-label uncontrolled study of 50 patients was conducted. All cases were treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. All patients were followed up for any complications or recurrence. Complete resolution of the lesion without any residual scar was seen in 100% of the cases, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response. The mean time to complete resolution was 14.77days. Recurrence was noted in one patient after 11months of resolution. Owing to the relative ease in application, lack of scarring and excellent response, we consider salt application to be an ideal treatment for PG lesions, especially in children and anxious patients reluctant to undergo any procedure.

Treatment of pyogenic granuloma with copper vapor laser radiation

Background. Pyogenic granuloma (PG) or lobular capillary hemangioma, ICD10 code: L98.0. appears as a single bright red or violet papule up to 20 mm in size, on the face, fingers, skull surface, arms, and intergluteal fold, as well as on the oral mucous membranes. Surgical removal of facial PG is not always possible due to insufficient thickness of the dermis. Treatment of PG with a pulsed dye laser (PDL) or neodymium laser (Nd:YAG) can achieve a noticeable elimination of the lesion but is reported to be accompanied by such side effects as purpura or scarring. It determines the feasibility of introducing into clinical practice the methods of laser treatment of PG using the radiation of a copper vapor laser (CVL) with a wavelength of 578 nm, which effectively absorbed by the blood.
 Aim. The assessment of the clinical efficacy and safety of the CVL treating PG.
 Methods. 26 adult patients with PG in various parts of the face, including the lips, limbs, and trunk, were included in this study. PG treatment was carried out in one session with CVL (Yakhroma-Med, FIAN) at an average power of 0.71.0 W, at a wavelength of 578 nm, exposure time 0.20.3 s. The diameter of the light spot is 1 mm.
 Results. Immediately after the single laser treatment, the PG involved area became grey. In 710 days, the irradiated area was utterly similar to the adjacent intact skin. No postoperative bleeding or infection was noted. Side effects included mild skin atrophy. During the follow-up observation for five years, no side effects were found.
 Conclusion. The high efficiency of PG elimination using CVL in the absence of pronounced side effects allows suggesting this method for introducing into dermatologists and cosmetologists' clinical practice as a highly effective and inexpensive method of treatment.

Polidocanol Sclerotherapy for the Treatment of Pyogenic Granuloma in Children.

Pyogenic granuloma (PG) is a benign vascular lesion that is commonly observed in the skin and mucosa. Sclerotherapy is the first-line conservative treatment option for PG. This retrospective study aimed to evaluate the efficacy of sclerotherapy with 1.0% polidocanol for the treatment of PG. All patients who were clinically diagnosed with PG consecutively at the Pediatric Outpatient Service of Qilu Children's Hospital of Shandong University from March 2018 to October 2019 received sclerotherapy with 1.0% polidocanol. The procedure resulted in the complete excision of PG, with inconspicuous scars. The procedure was well-tolerated, and recurrence was not observed. Allergic reactions, cutaneous necrosis, and pigmentary changes were not observed. Sclerotherapy with 1.0% polidocanol is considered an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome.

Topical β-blockers for pyogenic granulomas: A promising option for younger patients.

Topical β-blockers, propranolol, and timolol were used for pyogenic granuloma (PG) treatment; however, their efficacies and safety profiles were not compared. The aim was to evaluate the safety and efficacy of propranolol 1% and timolol 0.5% creams in the treatment of pyogenic granulomas. The study included 30 PG patients. They were divided into three groups (10 patients each). Group I patients received propranolol 1% cream. Group II patients used timolol 0.5% l cream. Group III patients used placebo cream. Creams were applied twice daily for 2months. Patients were followed up for 3months to detect any recurrence. Complete resolution was reported in 6 patients of groups I and II, while none of the control patients reported complete resolution. Despite the absent change in lesions' size in 40% of β-blockers treated groups, they all reported decreased bleeding tendency. There was insignificant difference between the clinical responses between β-blockers groups. No recurrence was reported in any of the patients who achieved complete resolution after 3months of follow-up. Younger patients respond better to β-blockers. Three patients were deteriorated on beta-blockers treatment. β-blockers are a promising PG treatment option in cases where invasive modalities are not desirable especially in younger patients.

Pyogenic granuloma: Case series

Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Case report: 4 patients reported to the Department of Oral Surgery, Army College of Dental Sciences, Secunderabad complaining of a swelling of gums in front and back tooth region in upper and lower arch for past 6 months. The treatment plan included surgical excision of the lesion using diode laser as well as scalpel.Results: All the Four patients reported no pain after the surgery. They were discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. No recurrence or scarring was observed in 6-12 months follow-up. Conclusion: Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

Treatment for Pyogenic Granuloma after Burns: A Retrospective, Single-Center Study Involving 15 Cases

Treatment for Pyogenic Granuloma after Burns: A Retrospective, Single-Center Study Involving 15 Cases

A potassium-titanyl-phosphate laser is an efficacious tool in the treatment of pyogenic granulomas. A retrospective study in 28 patients.

Pyogenic granuloma is a common benign vascular lesion of the skin and mucosa prone to ulceration and bleeding. Current therapeutic approaches include surgical excision, removal by means of electro caustic therapy, cryotherapy, and ablation with CO2 or vascular lasers. The purpose of this study was to investigate the efficacy of a 532 nm potassium-titanyl-phosphate laser (KTP-laser) for the treatment of pyogenic granulomas in terms of efficacy, advantages in clinical outcome, technique and associated side effects. In this retrospective study we report on the response of 28 consecutive patients with pyogenic granulomas at multiple locations on the skin after having been treated with a 532 nm KTP laser (532 nm AuraTM Star Pulse laser, Laserscope, CA, USA). Treatment was performed with a 2 mm handpiece and energy fluences of 35-60 J cm-2 and a laser pulse width of 50 ms or with a 1 mm handpiece and energy fluences of 200-240 J cm-2 and a laser pulse width of 50 ms. All patients were treated on an outpatient basis at the department of dermatology, Medical University of Vienna, Austria. In all of the 28 patients treated, we were able to demonstrate both symptomatic and clinical clearing of the lesions with excellent cosmetic results after the treatment. In 25 of the 28 patients a single treatment was sufficient to obtain optimal results. In three patients a second treatment session was required due to the recurrence of the lesion. The procedure required only local anesthesia, and postoperative care was limited to the application of a topical antibiotic ointment. No postoperative complications such as increased pain or wound infection and only minimal scarring were observed. This experience with excellent patient satisfaction suggests that treatment of pyogenic granulomas with the KTP laser is a safe, effective, and reasonable alternative to conventional therapy. As with many other limited interventions with this laser technology, the advantages include minimal postoperative pain, conservative site-specific minimally invasive surgeries and a very satisfactory cosmetic result with a high acceptance rate on the side of the patients.