From the Guidelines
Pyogenic granuloma, also known as lobular capillary hemangioma, should be treated with topical timolol 0.5% gel, applied twice daily under occlusion for 1 month, as it has shown complete clearance of lesions in patients treated with EGFR inhibitors, as reported in a recent study 1. The diagnosis of pyogenic granuloma is typically based on clinical presentation, and it is essential to rule out other conditions such as amelanotic melanoma or squamous cell carcinoma.
- Key characteristics of pyogenic granuloma include: + Rapid growth over weeks to months + Prone to bleeding with minimal trauma due to rich vascular network + Typically 5-10mm in size
- Treatment options, in addition to topical timolol, may include: + Silver nitrate application + Cryotherapy + Surgical excision or shave removal with electrocautery for larger or recurrent lesions + High-potency topical corticosteroids alone or combined with topical antibiotics for conservative management
- It is crucial to monitor patients closely for early symptoms suggestive of pyogenic granuloma and to provide preventive measures, such as gentle skin care instructions and avoidance of repeated friction and trauma, to reduce the risk of developing this condition 1.
- In cases where lesions are intolerable or grade 2 or 3 paronychia/pyogenic granuloma, surgical treatment with partial nail plate removal may be necessary 1.
From the Research
Diagnosis of Pyogenic Granuloma
- Pyogenic granuloma, also known as lobular capillary hemangioma, is a common benign vascular proliferation of not yet fully understood aetiology 2
- It can occur in all age groups and affect both men and women 2
- Differential diagnosis may include malignant tumours such as amelanotic melanoma, basal cell carcinoma, and spindle cell tumour 2
Treatment Options for Pyogenic Granuloma
- Surgical excision with primary closure is the usual treatment for pyogenic granuloma/lobular capillary haemangioma and has the lowest rate of recurrence 2
- Other treatment options include: + Topical imiquimod 3 + Cryotherapy 3, 4 + Electrodessication and curettage 3, 5 + Excision 3, 4 + Laser therapy (e.g. Er:YAG laser, 585 nm pulsed dye laser) 3, 4, 5 + Sclerotherapy 3 + Microembolization 3 + Topical timolol 6
Specific Treatment Approaches
- A case of recalcitrant pyogenic granuloma was successfully treated with aggressive laser therapy, intralesional triamcinolone acetonide injections, and topical timolol application 3
- Er:YAG laser was used to treat a pyogenic granuloma on the gingiva, resulting in complete healing and no recurrence after 9 months 4
- Topical timolol 0.5% ophthalmic gel was used to treat a pyogenic granuloma on the finger, resulting in complete resolution and no recurrence after 7 months 6
- The 585 nm pulsed dye laser was used to treat pyogenic granulomas, resulting in symptomatic and clinical clearing of the lesions with excellent cosmetic results in 16 out of 18 patients 5