Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Authors

  • Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden
  • Dana Langner Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden
  • Katlein França Department of Dermatology & Cutaneous Surgery, and Department of Psychiatry & Behavioral Sciences, Institute for Bioethics & Health Policy, University of Miami Miller School of Medicine, Miami, FL
  • Serena Gianfaldoni Dermatological Department University of Pisa, Pisa
  • Torello Lotti Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome
  • Georgi Tchernev Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, and Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia

DOI:

https://doi.org/10.3889/oamjms.2017.111

Keywords:

Pyogenic granuloma, benign vascular tumours, BRAF mutations, virus, surgery, beta-adrenergic receptor antagonists

Abstract

Pyogenic granuloma is a common benign vascular tumour occurring in all ages. Both skin and mucous membranes can be affected. Of pathogenetic importance are trauma, BRAF mutations and probably herpes virus type 1, Orf virus and/or human papilloma virus type 2. The tumour consists of capillary proliferations, venules and fibromyxoid stroma. The development of a lesion occurs in three stages and bleeding is a common symptom. The tumour can mimic various other vascular lesions, solid tumours, and soft tissue infections. In recent years, targeted tumour therapies have become the most common cause of drug-induced pyogenic granulomas. The backbone of treatment is surgical procedures including laser therapy. New developments in medical drug therapy include topical and systemic beta-adrenergic receptor antagonists timolol and propranolol. Drug therapy is an alternative for young children, ocular and periungual pyogenic granuloma.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Giblin AV, Clover AJ, Athanassopoulos A, Budny PG. Pyogenic granuloma - the quest for optimum treatment: an audit of treatment of 408 cases. J Plast Reconstr Aesthet Surg. 2007;60(9):1030-5. https://doi.org/10.1016/j.bjps.2006.10.018 PMid:17478135

Simmons BJ, Chen L, Hu S. Pyogenic granuloma association with isotretinoin treatment for acne. Australas J Dermatol. 2016;57(4):e144-5. https://doi.org/10.1111/ajd.12418 PMid:27885661

Massa A, Antunes A, Varela P. Pyogenic granuloma in a patient on gefitinib. Acta Med Port. 2016;29(6):416. https://doi.org/10.20344/amp.6343 PMid:27865223

Fujiwara C, Motegi SI, Sekiguchi A, Amano H, Ishikawa O. Pyogenic granuloma possibly associated with capecitabine therapy. J Dermatol. 2016. https://doi.org/10.1111/1346-8138.13691

Inoue A, Sawada Y, Nishio D, Nakamura M. Pyogenic granuloma caused by afatinib: Case report and review of the literature. Australas J Dermatol. 2017;58(1):61-2. https://doi.org/10.1111/ajd.12423 PMid:26603180

Henning B, Stieger P, Kamarachev J, Dummer R, Goldinger SM. Pyogenic granuloma in patients treated with selective BRAF inhibitors: another manifestation of paradoxical pathway activation. Melanoma Res. 2016;26(3):304-7. https://doi.org/10.1097/CMR.0000000000000248 PMid:27116335

Robert C, Sibaud V, Mateus C, Verschoore M, Charles C, Lanoy E, Baran R. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015;16(4):e181-9. https://doi.org/10.1016/S1470-2045(14)71133-7

Wollina U. Multiple eruptive periungual pyogenic granulomas during anti-CD20 monoclonal antibody therapy for rheumatoid arthritis. J Dermatol Case Rep. 2010;4(3):44-6. https://doi.org/10.3315/jdcr.2010.1050 PMid:21886749 PMCid:PMC3157817

Marla V, Shrestha A, Goel K, Shrestha S. The histopathological spectrum of pyogenic granuloma: A case series. Case Rep Dent. 2016;2016:1323798. https://doi.org/10.1155/2016/1323798

Seyedmajidi M, Shafaee S, Hashemipour G, Bijani A, Ehsani H. Immunohistochemical evaluation of angiogenesis related markers in pyogenic granuloma of gingiva. Asian Pac J Cancer Prev. 2015;16(17):7513-6. https://doi.org/10.7314/APJCP.2015.16.17.7513 PMid:26625754

Groesser L, Peterhof E, Evert M, Landthaler M, Berneburg M, Hafner C. BRAF and RAS mutations in sporadic and secondary pyogenic granuloma. J Invest Dermatol. 2016;136(2):481-6. https://doi.org/10.1038/JID.2015.376

El Hayderi L, Rübben A, Nikkels AF. [The alpha-herpesviridae in dermatology: Herpes simplex virus types I and II. German version]. Hautarzt. 2017;68(3):181-6. https://doi.org/10.1007/s00105-016-3929-5 PMid:28197699

Biyik Ozkaya D, Taskın B, Tas B, Asıran Serdar Z, Demirkesen C, Su O, Onsun N. Poxvirus-induced angiogenesis after a thermal burn. J Dermatol. 2014;41(9):830-3. https://doi.org/10.1111/1346-8138.12589 PMid:25110123

Ran M, Lee M, Gong J, Lin Z, Li R. Oral acyclovir and intralesional interferon injections for treatment of giant pyogenic granuloma-like lesions in an immunocompromised patient with human Orf. JAMA Dermatol. 2015;151(9):1032-4. https://doi.org/10.1001/jamadermatol.2015.0760 PMid:25946461

Vázquez-Martínez OT, González-Betancourt A, Barboza-Cerda MC, González-González SE, Lugo-Trampe Ã, Welsh O, Rojas-Martínez A, Martínez-Rodríguez HG, Ocampo-Candiani J, Ortiz-López R. Human papillomavirus type 2 associated with pyogenic granuloma in patients without clinical evidence of warts. Int J Dermatol. 2015;55(7):745-50. https://doi.org/10.1111/ijd.12982 PMid:26492599

Tobouti PL, Olegário I, de Sousa SC. Benign vascular lesions of the lips: Diagnostic approach. J Cutan Pathol. 2017;44(5):451-5. https://doi.org/10.1111/cup.12911 PMid:28111788

daSilva FC, Piazzetta CM, Torres-Pereira CC, Schussel JL, Amenábar JM. Gingival proliferative lesions in children and adolescents in Brazil: A 15-year-period cross-sectional study. J Indian Soc Periodontol. 2016;20(1):63-6. https://doi.org/10.4103/0972-124X.168493 PMid:27041840 PMCid:PMC4795138

Wollina U. Subungual telangiectatic granuloma. Dtsch Arztebl Int. 2017;114(8):136. PMid:28302264 PMCid:PMC5374259

Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz ÉB, Fontoura Nogueira da Cruz MC. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res. 2017;43(1):16-22. https://doi.org/10.1111/jog.13150 PMid:28074549

Abreu-Dos-Santos F, Câmara S, Reis F, Freitas T, Gaspar H, Cordeiro M. Vulvar lobular capillary hemangioma: A rare location for a frequent entity. Case Rep Obstet Gynecol. 2016;2016:3435270. https://doi.org/10.1155/2016/3435270

Katmeh RF, Johnson L, Kempley E, Kotecha S, Hamarneh W, Chitale S. Pyogenic granuloma of the penis: An uncommon lesion with unusual presentation. Curr Urol. 2017;9(4):216-8. https://doi.org/10.1159/000447144 PMid:28413384 PMCid:PMC5385862

Zhao J, Feng Q, Shi S. Pyogenic granuloma of the esophagus. Clin Gastroenterol Hepatol. 2017. https://doi.org/10.1016/j.cgh.2017.03.028

Romero Mascarell C, García Pagán JC, Araujo IK, Llach J, González-Suárez B. Pyogenic granuloma in the jejunum successfully removed by single-balloon enteroscopy. Rev Esp Enferm Dig. 2017;109(2):152-4. PMid:28196424

Qiu X, Dong Z, Zhang J, Yu J. Lobular capillary hemangioma of the tracheobronchial tree: A case report and literature review. Medicine (Baltimore). 2016;95(48):e5499. https://doi.org/10.1097/MD.0000000000005499 PMid:27902613 PMCid:PMC5134768

Misawa S, Sakamoto H, Kurogochi A, Kirii Y, Nakamura S, Misawa T, Yoneda S, Hirano M, Owa O, Takagi H, Ota H. Rare cause of severe anemia due to pyogenic granuloma in the jejunum. BMC Gastroenterol. 2015;15:126. https://doi.org/10.1186/s12876-015-0355-6 PMid:26444414 PMCid:PMC4596517

Matsuzaki K, Imamura Y, Ozawa M, Nakajima T, Ikeda A, Konishi T, Jikuya T. Intravenous lobular capillary hemangioma in the subclavian vein. Ann Thorac Surg. 2016;102(5):e427-9. https://doi.org/10.1016/j.athoracsur.2016.04.013 PMid:27772599

Brightman LA, Geronemus RG, Reddy KK. Laser treatment of port-wine stains. Clin Cosmet Investig Dermatol. 2015;8:27-33. PMid:25624768 PMCid:PMC4296879

Wollina U, Zielinski M, Knopf B, Hipler C. [Eruptive capillary hemangioma following argon laser therapy of naevus flammeus]. Hautarzt. 1989;40(4):212-4. PMid:2732049

Rana R, Ramachandra SS, Prasad UC, Aggarwal P, Dayakara JK. Recurrent pyogenic granuloma with a satellite lesion. Cutis. 2015;96(2):E27-30. PMid:26367761

Gupta V, Mridha AR, Sharma VK. Pediatric Dermatology Photoquiz: Multiple erythematous papules on the back. Recurrent pyogenic granulomas with satellitosis. Pediatr Dermatol. 2016;33(1):97-8. https://doi.org/10.1111/pde.12700 PMid:26758098

Putra J, Rymeski B, Merrow AC, Dasgupta R, Gupta A. Four cases of pediatric deep-seated/subcutaneous pyogenic granuloma: Review of literature and differential diagnosis. J Cutan Pathol. 2017. https://doi.org/10.1111/cup.12923 PMid:28233342

Ryan P, Aarons S, Murray D, Markham T, O'Sullivan S, Lyons F, Lee G, Fitzgibbon J. Human herpesvirus 8 (HHV-8) detected in two patients with Kaposi's sarcoma-like pyogenic granuloma. J Clin Pathol. 2002;55(8):619-22. https://doi.org/10.1136/jcp.55.8.619 PMid:12147659 PMCid:PMC1769721

Bains A, Vedant D, Shanker V, Tegta GR. Primary cutaneous anaplastic large cell lymphoma masquerading as large pyogenic granuloma. Indian Dermatol Online J. 2016;7(6):526-8. https://doi.org/10.4103/2229-5178.193896 PMid:27990392 PMCid:PMC5134171

Kumar P, Das A, Mondal A, Savant SS. Pyogenic granuloma-like basal cell carcinoma on the abdomen: A deceptive presentation. Indian Dermatol Online J. 2016;7(5):446-448. https://doi.org/10.4103/2229-5178.190502 PMid:27730056 PMCid:PMC5038121

Jafarian F, Powell J, Kokta V, Champagne M, Hatami A, McCuaig C, Marcoux D, Savard P. Malignant melanoma in childhood and adolescence: report of 13 cases. J Am Acad Dermatol. 2005;53(5):816-22. https://doi.org/10.1016/j.jaad.2005.07.013 PMid:16243130

Khader A, Ambooken B, Binitha MP, Francis S, Kuttiyil AK, Sureshan DN. Disseminated cutaneous due to Cladophialophora bantiana. Indian J Dermatol Venereol Leprol. 2015;81(5):491-4. https://doi.org/10.4103/0378-6323.162333 PMid:26261143

Bolton JG, Galeckas KJ, Satter EK. Inoculation bartonellosis in an adult: a case report. Cutis. 2010;85(1):37-42. PMid:20184210

Al-Mohaya MA, Al-Malik AM. Excision of oral pyogenic granuloma in a diabetic patient with 940nm diode laser. Saudi Med J. 2016;37(12):1395-1400. https://doi.org/10.15537/smj.2016.12.15941 PMid:27874157 PMCid:PMC5303780

Hasanoglu Erbasar GN, Senguven B, Gultekin SE, Cetiner S. Management of a recurrent pyogenic granuloma of the hard palate with diode laser: A case report. J Lasers Med Sci. 2016;7(1):56-61. https://doi.org/10.15171/jlms.2016.12 PMid:27330700 PMCid:PMC4908978

Wollina U. Three hundred patients treated with ultrapulsed 980 nm diode laser for skin disorders. Indian J Dermatol. 2016;61(5):540-4. https://doi.org/10.4103/0019-5154.190111 PMid:27688445 PMCid:PMC5029241

Au S, Fancher W, Scribner J. Treatment of pediatric pyogenic granuloma in a functionally and cosmetically sensitive area with the 1064nm Nd:Yag laser. Dermatol Online J. 2016;22(4). PMid:27617472

Goldman A, Rossata F, Wollina U. Versatility of the Nd-YAG laser in the treatment of facial vascular alterations. Kosmet Med 2008;29:134-7.

Fekrazad R, Nokhbatolfoghahaei H, Khoei F, Kalhori KA. Pyogenic granuloma: surgical treatment with Er:YAG laser. J Lasers Med Sci. 2014;5(4):199-205. PMid:25653822 PMCid:PMC4281984

Truschnegg A, Acham S, Kqiku L, Beham A, Jakse N. CO2 laser excision of a pyogenic granuloma associated with dental implants: A case report and review of the literature. Photomed Laser Surg. 2016;34(9):425-31. PMid:27420917

Liu J, Zhou BR, Yi F, Wu HJ, Zhang JA, Luo D. Pyogenic granuloma in a patient with psoriasis successfully treated by 5-aminolevulinic acid photodynamic therapy: A case report. Exp Ther Med. 2016;11(1):345-347. PMid:26889266

Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using β-adrenergic receptor antagonists. Pediatr Dermatol. 2014;31(2):203-7. https://doi.org/10.1111/pde.12217 PMid:24138457

Piraccini BM, Alessandrini A, Dika E, Starace M, Patrizi A, Neri I. Topical propranolol 1% cream for pyogenic granulomas of the nail: open-label study in 10 patients. J Eur Acad Dermatol Venereol. 2016;30(5):901-2. https://doi.org/10.1111/jdv.13071 PMid:25708373

Oke I, Alkharashi M, Petersen RA, Ashenberg A, Shah AS. Treatment of ocular pyogenic granuloma with topical timolol. JAMA Ophthalmol. 2017;135(4):383-5. https://doi.org/10.1001/jamaophthalmol.2017.0110 PMid:28301661

de Graaf M, Breur JM, Raphaël MF, Vos M, Breugem CC, Pasmans SG. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol. 2011;65(2):320-7. https://doi.org/10.1016/j.jaad.2010.06.048 PMid:21601311

Müller ME, van der Velde N, Krulder JW, van der Cammen TJ. Syncope and falls due to timolol eye drops. BMJ. 2006;332(7547):960-1. https://doi.org/10.1136/bmj.332.7547.960 PMid:16627515 PMCid:PMC1444852

Published

2017-07-19

How to Cite

1.
Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G. Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options. Open Access Maced J Med Sci [Internet]. 2017 Jul. 19 [cited 2021 Oct. 24];5(4):423-6. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2017.111

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>