Pyogenic Granuloma: A Common Vascular Tumor

Pyogenic granuloma or lobular capillary hemangioma develops in skin tissues. It can also occur in the mouth and, rarely, the gastrointestinal tract. The lesions most often appear as single bumps, but can also develop in patches, called plaques. They grow quickly and, though uncommon, can may become ulcers on the surface of the skin.

Pyogenic granuloma can occur during pregnancy. This type is called granuloma gravidarum and most commonly appears in the mouth during the second or third trimester. In some rare cases, the growths have developed on women taking birth control pills and in people who have recently had a transplant.

Pyogenic granuloma is usually diagnosed through a simple physical exam, though the physician may do a biopsy to confirm the diagnosis. While these growths are always benign, they look like some malignant or cancerous lesions and could be misdiagnosed. Although this is rare, biopsies are helpful for long-term management, as many pyogenic granulomas recur after treatment.

Signs and symptoms of pyogenic granuloma are straightforward. They are small, solid red bumps or plaques that may bleed easily if bumped or scratched. People often find them on the site of a recent injury, usually on the face, hands, or arms. Some pregnant women get them in their mouths.

The exact cause of pyogenic granuloma is unknown. There is speculation that it may result from an imbalance of factors involved in blood vessel growth, which causes capillaries to grow too quickly. Though there may be some correlation between pyogenic granuloma and injury, only about seven percent are directly related to tissue trauma.

As pyogenic granuloma appears during pregnancy, hormonal factors may play a role. Women develop more pyogenic granulomas in their childbearing years, and some researchers think that estrogen and other sex hormones increase the inflammatory responses in the tissue of the mouth. However, this theory is refuted by others because the growths almost never develop in the vaginal tissues.

While some studies show pyogenic granuloma are slightly more prevalent in men than women, mucosal lesions are more common in women before age 40. Men are more likely to develop pyogenic granuloma on the skin and in the mouth at a younger age, between childhood and age 30, whereas they are more common in women between 30 and 40. In children, pyogenic granuloma is more common in six- to 10-year-old boys.

Treatment depends on where the lesion is located. Most pyogenic granulomas are scraped off and lightly cauterized to limit the chances of regrowth. Some physicians prefer topical, chemical-based treatments. Laser surgery is effective but some studies suggest that it may not be the best option. The most effective treatment is surgical excision, removing the underlying tissue, and stitching the incision. As for pyogenic granuloma during pregnancy, it usually disappears on its own after delivery.

Excision and cauterization are the preferred treatment for cosmetic areas, but it is common for pyogenic granuloma to return, especially when it is prompted by medication. Women who have it with one pregnancy may develop it again the next time they get pregnant. Sometimes, muliple, smaller lesions appear after treatment, which may suggest that pyogenic granuloma can spread through the blood vessels.

Pyogenic granuloma is benign and does not become malignant, but it does not go away on its own, except in some pregnant women. Complications include bleeding, ulceration, and secondary infections if the lesion is not properly treated. Depending on where they appear, they can cause cosmetic disfigurement.