Treatment of Umbilical Granuloma
Silver nitrate cauterization is the first-line treatment for umbilical granuloma, with common salt application under occlusion being an effective alternative when silver nitrate is unavailable. 1, 2, 3
What is an Umbilical Granuloma?
An umbilical granuloma is the most common umbilical abnormality in neonates, characterized by:
- Overgrowth of granulation tissue at the base of the umbilical cord after separation
- Cherry-red, moist, soft tissue that may have serous discharge
- Failure to epithelialize and persistence beyond 2 months
- Occasional bleeding or drainage
Treatment Options
First-Line Treatment: Silver Nitrate Cauterization
- Apply 75% silver nitrate stick directly to the granuloma 1, 2
- Usually requires 2-3 applications over multiple visits
- Mechanism: Chemical cauterization that destroys granulation tissue
Alternative Treatments (when silver nitrate is unavailable):
Common Salt Application (Table Salt)
- Clean the area thoroughly
- Apply common table salt directly to the granuloma
- Cover with surgical adhesive tape for 24 hours
- Remove tape and gently clean away the shrunken tissue
- Complete resolution typically occurs within 24 hours
- Mechanism: Osmotic desiccation of the granulation tissue 3
Topical Clobetasol Propionate Cream (0.05%)
- Apply at home by parents
- As effective as silver nitrate with identical healing times and resolution rates
- Advantage: Can be administered at home, avoiding multiple clinic visits 4
Surgical Excision
- For persistent cases or larger granulomas
- Excision followed by application of absorbable hemostatic materials
- One-time procedure with uneventful healing 2
Treatment Algorithm
Initial Assessment
- Confirm diagnosis (cherry-red, soft, moist granulation tissue at umbilicus)
- Rule out other umbilical anomalies (polyp, hernia, omphalomesenteric duct remnant)
First-Line Treatment
- Apply silver nitrate stick directly to granuloma
- Protect surrounding skin to prevent chemical burns
- Repeat application after 1-2 weeks if needed
If Silver Nitrate Unavailable or Failed
- Try common salt application under occlusion for 24 hours OR
- Prescribe topical clobetasol propionate cream (0.05%) for home application
For Persistent Cases
- Consider surgical excision
Important Considerations and Pitfalls
- Avoid silver nitrate spillage onto surrounding skin to prevent chemical burns
- Ensure proper diagnosis before treatment - umbilical granuloma must be differentiated from umbilical polyp, hernia, or omphalomesenteric duct remnant
- Monitor for infection during treatment process
- Single application of salt under occlusion may be sufficient for complete resolution, making it a cost-effective option
- Parent education about keeping the umbilical area clean and dry is essential
The histopathology of umbilical granuloma shows granulation tissue composed of fibroblasts, inflammatory cells, and vascular endothelial cells in an edematous stroma 5, confirming its benign nature and distinguishing it from other potentially more significant umbilical anomalies.