What is the treatment for a granuloma (inflammatory growth) of the umbilicus (belly button)?

Treatment of Umbilical Granuloma

The most effective first-line treatment for umbilical granuloma is application of table salt (NaCl) under occlusion for 24 hours, which achieves complete resolution with a single application and minimal complications. 1

Definition and Pathology

• Umbilical granuloma is the most common umbilical abnormality in neonates, characterized by an overgrowth of granulation tissue that persists at the base of the umbilical cord after its separation 2, 3
• Histologically, it consists of granulation tissue composed of fibroblasts, inflammatory cells, and vascular endothelial cells in an edematous stroma 3
• The condition affects approximately 5.9% of neonates, with annual incidence rates ranging from 3.8% to 7.3% 4

Risk Factors

• Gestational age, birth weight, and meconium-stained amniotic fluid are significantly associated with umbilical granuloma development 4
• Most umbilical granulomas fail to epithelialize and persist for more than 2 months if left untreated 2

Treatment Options

First-Line Treatment: Salt Application

• Apply common table salt (NaCl) directly to the granuloma after cleaning the area 1, 5
• Occlude with surgical adhesive tape for 24 hours 1
• Remove the occlusive tape after 24 hours and gently clean the area to remove the shrunken tissue 1
• Complete resolution can be achieved with a single application in up to 89% of cases 5
• Salt causes shrinkage of the granuloma through a desiccant effect in the occluded hyperosmolar environment 1
• Benefits include low cost, ease of application, and minimal complications 1, 5

Alternative Treatments

• Topical betamethasone valerate has shown a 97.7% healing rate during initial treatment and has become a predominant treatment option in recent years 4
• Silver nitrate cauterization has a 91% healing rate but carries risk of chemical burns to surrounding tissues 2, 4
• Surgical excision with application of absorbable hemostatic materials has shown uneventful healing in all cases with no complications 2
• Ligation has shown an 88% healing rate and may be considered when other treatments fail 4

Treatment Algorithm

1. First attempt: Table salt application under occlusion for 24 hours 1, 5
2. If unsuccessful: Topical betamethasone valerate application 4
3. For persistent cases: Silver nitrate cauterization or surgical excision/ligation 2, 4

Follow-up and Monitoring

• Follow up after 24-48 hours of initial treatment to assess response 1
• Monitor for 3 months to ensure no recurrence 1, 5
• If no improvement is seen after initial treatment, proceed to alternative treatment options 4

Advantages of Salt Treatment

• Single application is usually sufficient 1
• Physician-controlled application ensures accuracy 1
• No reported major complications or recurrences 1, 5
• Eliminates need for repeated outpatient visits 2
• Cost-effective and readily available treatment 1, 5

Salt therapy represents a simple, effective, and safe approach to treating this common neonatal condition, with minimal risk and high success rates compared to traditional methods.