What causes pyogenic granuloma?

Pyogenic Granuloma Causes

Pyogenic granuloma, also known as lobular capillary hemangioma, is primarily caused by trauma, chronic irritation, hormonal imbalances, and certain medications, leading to reactive vascular proliferation despite being neither pyogenic nor granulomatous in nature. 1

Classification and Nature

• Pyogenic granuloma is classified as a benign vascular tumor according to the International Society for the Study of Vascular Anomalies (ISSVA) classification system 1
• Despite its name, pyogenic granuloma is neither pyogenic (pus-producing) nor granulomatous, but rather a reactive proliferating vascular lesion 1
• It is considered a common acquired vascular lesion of the skin and mucous membranes that primarily affects infants and children 1

Common Etiological Factors

• Trauma: Physical injury is one of the most common causes of pyogenic granuloma development 2

  • Acute trauma can trigger the formation of even giant pyogenic granulomas, as documented in case reports 2
  • Minor trauma or constant low-grade irritation can initiate the reactive vascular proliferation 3

• Chronic irritation: Persistent irritation to tissues can lead to pyogenic granuloma formation 4

  • Poor oral hygiene is a significant contributing factor, especially for oral lesions 3
  • Chronic low-level irritation is considered the most common etiology 2

• Hormonal factors: Hormonal imbalances can trigger the development of pyogenic granuloma 4

  • This explains why these lesions are sometimes associated with pregnancy or hormonal changes

• Medications: Various drugs can induce pyogenic granuloma as a side effect 4

• Burns: Thermal injuries can lead to the development of multiple, eruptive pyogenic granulomas on burned skin, though this is relatively rare 5

• Infection: Chronic, low-grade infections may contribute to the development of pyogenic granuloma, particularly in oral cases 3

Clinical Characteristics

• Pyogenic granulomas most commonly occur on the head and neck region 1
• They typically present as rapidly enlarging lesions with a median size of 6.5 mm 1
• These lesions frequently develop a pedunculated base and are prone to bleeding that is difficult to control when eroded 1
• Approximately 12% occur in infancy, and 42% present during the first 5 years of life 1

Diagnostic Considerations

• Pyogenic granulomas are frequently misdiagnosed as infantile hemangiomas 1
• Histological examination is essential to rule out malignancy, as some atypical presentations may clinically mimic malignant tumors 4
• Proper diagnosis is crucial as pyogenic granulomas can be confused with other vascular lesions 6

Unusual Presentations

• Subcutaneous and intravascular pyogenic granulomas are rare variants that can occur without preceding trauma 7
• Multiple, eruptive pyogenic granulomas can develop on burned skin, representing an uncommon presentation 5
• Recurrent forms may require alternative treatment approaches beyond surgical excision 4