Pyogenic granuloma, despite its misleading name, is neither pyogenic (pus-forming) nor a true granuloma. Instead, it is a benign vascular lesion characterized by an overgrowth of capillaries within the skin or mucous membranes. These lesions, also known as lobular capillary hemangiomas, are common in both children and adults and are typically seen following minor trauma or hormonal changes. 

Pyogenic granulomas are of clinical interest not only because of their rapid growth and tendency to bleed easily but also because they can mimic more serious conditions, including malignancies.  

Pyogenic granuloma is a common benign vascular lesion that arises due to abnormal proliferation of small blood vessels (capillaries) within the skin or mucous membranes. Despite its name, it is neither associated with pus formation nor a true granuloma histologically. Instead, it reflects a reactive process triggered by local irritation, trauma, or hormonal changes. 

Clinical Features: 

• Small, bright red or purple papule or nodule 

• Smooth or lobulated surface 

• Rapid growth over weeks 

• Bleeds easily with minor trauma 

• Pedunculated (stalked) or sessile (broad-based) 

• Usually a few millimeters to 2 cm in size 

Alternative Names: Lobular capillary hemangioma, eruptive hemangioma 

Epidemiology: 

• Occurs at any age, but most frequent in children and young adults 

• Common in women during pregnancy, leading to “pregnancy tumor” (granuloma gravidarum) on the gums 

• Mucosal lesions are somewhat more common in females due to hormonal factors 

The exact cause of pyogenic granuloma is not fully understood, but several contributing factors are recognized: 

• Trauma and Local Irritation: Minor injuries, insect bites, or repeated friction can trigger lesion development. Common sites: hands, fingers, face, oral mucosa. 

• Hormonal Factors: Pregnancy-associated hormonal changes often lead to gingival lesions. 

• Medications: Drugs associated with PG include oral contraceptives, retinoids, indinavir, and some chemotherapeutic agents. 

• Other Factors: Infections are not direct causes, though the name implies otherwise. Genetic predisposition and angiogenic factors may contribute. 

PG develops from an exaggerated angiogenic response, resulting in abnormal growth of capillaries at a site of irritation or hormonal influence. 

Pathophysiology: 

• Local trauma stimulates release of vascular endothelial growth factor (VEGF) and other signals 

• Rapid proliferation of capillaries in lobular patterns 

• Hormonal changes enhance this process, especially on mucosal surfaces 

Histological Features: 

• Capillaries arranged in lobules, separated by thin fibrous septa 

• Thin, fragile overlying epithelium 

• Prone to ulceration and bleeding 

Pyogenic granulomas draw attention because of their rapid growth and tendency to bleed. 

General Characteristics: 

• Appearance: Small, red to reddish-purple papule or nodule 

• Shape: Pedunculated or sessile 

• Size: A few mm to ~2 cm 

• Growth rate: Rapid, over days to weeks 

• Texture: Soft, compressible, with fragile surface 

Bleeding Tendency: 

• Bleeds easily with minor trauma (tooth brushing, friction from clothing) 

• Bleeding may be disproportionate to lesion size 

• Recurrent bleeding is common in exposed areas 

Pain and Discomfort: 

• Most lesions are painless 

• Ulcerated or repeatedly traumatized lesions may be tender 

• Pain can also occur if secondarily infected 

Common Locations: 

• Skin: fingers, hands, forearms, face, neck, scalp 

• Oral mucosa: gingiva, lips, tongue, buccal mucosa 

• Other: conjunctiva, nasal mucosa, genitals (rare) 

Pregnancy-Related Lesions: 

• Granuloma gravidarum usually arises on gums 

• Appears in second or third trimester 

• May regress postpartum, though some persist 

Special Forms: 

• Multiple lesions (rare; can follow trauma, burns, isotretinoin, or chemotherapy) 

• Subungual lesions (beneath nails, causing nail deformity or pain) 

Diagnosis is usually clinical but confirmed with supportive tools when needed. 

Clinical Evaluation: 

• Rapidly growing, red/purple papule or nodule 

• Smooth or lobulated, pedunculated or sessile 

• Easily bleeds with minor trauma 

• History of local injury, irritation, or pregnancy 

Dermoscopy: 

• Homogeneous reddish areas (capillary proliferation) 

• White rail-like lines (fibrous septa) 

• Ulceration or crusting 

Histopathology: 

• Recommended when lesions are atypical, unusually large, irregular, pigmented, or nonresponsive to treatment 

• Shows lobular capillary proliferation with thin or ulcerated overlying epithelium 

Further Tests: Rarely needed; only for atypical or unusual sites (e.g., nasal cavity, conjunctiva) 

Differential Diagnosis 

PG must be distinguished from malignant and benign mimics: 

• Amelanotic melanoma 

• Basal cell carcinoma (ulcerated) 

• Squamous cell carcinoma 

• Kaposi’s sarcoma 

• Hemangioma (especially in infants) 

• Verruca vulgaris (wart) 

• Cutaneous metastasis (rare) 

Treatment aims to remove the lesion, control bleeding, and reduce recurrence risk. 

Non-Surgical Options: 

• Topical imiquimod or timolol (off-label) 

• Laser therapy (pulsed dye, Nd:YAG) 

• Cryotherapy with liquid nitrogen 

Surgical Options: 

• Excisional surgery with base curettage (allows histopathology) 

• Electrosurgery or cauterization (for small lesions) 

• Shave excision (pedunculated lesions) 

• Conservative management for pregnancy lesions (often regress postpartum) 

Prognosis: The prognosis is excellent because pyogenic granuloma is a benign condition. 

Recurrence: 

• Higher with incomplete removal or simple curettage 

• Lower with full excision including base 

Complications: 

• Persistent bleeding 

• Cosmetic concerns (scarring) 

While prevention is not always possible, measures include: 

• Minimize trauma in high-friction areas 

• Maintain good oral hygiene 

• Manage contributing hormonal or medication-related factors when feasible 

Pyogenic granuloma is a common benign vascular tumor that presents with rapid growth and frequent bleeding. Although harmless, its resemblance to malignant lesions requires careful diagnosis. Treatment usually involves minor surgical procedures, though nonsurgical methods may be suitable in some cases. Prognosis is excellent, but recurrence occurs if lesions are incompletely removed. Awareness of its causes, presentation, and treatment helps clinicians manage patients effectively and reassure them. 

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2. Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): A clinicopathologic study of 178 cases. Pediatr Dermatol. 1991;8(4):267-276. 

3. Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004;21(1):10-13. 

4. Janier M, Reynaud-Mendel B, Courville P. Pyogenic granuloma: Clinical and histopathological study of 122 cases. Ann Dermatol Venereol. 1997;124(7-8):401-405.