[Pyogenic granuloma: a frequent and often misunderstood entity in primary care medicine]. / Botriomycome : une entité courante et souvent méconnue en médecine de premier recours.

Botriomycoma, also called pyogenic granuloma, is a common benign skin lesion that usually forms as a result of skin irritation. Although it is considered benign, its potential appearance as a malignant tumor can cause great concern in patients and lead to demand for prompt treatment. This article reviews the current knowledge about this lesion, including its possible causes, clinical manifestations, and treatment options.

Le botriomycome, aussi appelé granulome pyogénique, est une lésion cutanée bénigne courante qui se forme généralement à la suite d'une irritation de la peau. Bien qu'il soit considéré comme bénin, son apparence potentielle de tumeur maligne peut susciter une grande inquiétude chez les patients et entraîner une demande de traitement rapide. Cet article recense les connaissances actuelles sur cette lésion, y compris ses causes possibles, ses manifestations cliniques et les options de traitement.

Management of Bleeding Pyogenic Granulomas in Acute Care Settings.

BACKGROUND: Pyogenic granulomas are acquired, benign growths of capillary blood vessels that are commonly seen in the pediatric population. Patients with these lesions often present to emergency departments and urgent care centers with persistent bleeding after minor trauma. Much of the published literature describing the management of pyogenic granulomas, however, is focused on outpatient or definitive therapies, and there is limited information on the management of acute bleeding. OBJECTIVE: We conducted a narrative review to present and evaluate strategies and therapies available to emergency physicians for managing actively bleeding pyogenic granulomas in acute care settings. DISCUSSION: Multiple options are available to emergency physicians to achieve hemostasis. Direct pressure with a nonadherent dressing remains first-line treatment. Additional therapeutic options, such as dressings impregnated with topical vasoconstrictors or hemostatic dressings or agents, can be used if bleeding persists. Certain approaches-silver nitrate, suture ligation, or electrocautery-may be available to some emergency physicians. These therapies, however, can compromise future histologic analysis of tissue for definitive diagnosis and have potential risks. CONCLUSION: Although there are multiple options to achieve hemostasis in cases of bleeding, some treatments may lead to suboptimal cosmesis or interfere with future management. Many bleeding pyogenic granulomas will become hemostatic with treatments available to emergency physicians. Surgical consultation may be warranted for pyogenic granulomas that are unresponsive to the therapies described in this review.

Polidocanol Sclerotherapy in Pyogenic Granulomas.

BACKGROUND: Polidocanol is a safe sclerosing agent with anesthetic properties and minimal skin toxicity. OBJECTIVE: To evaluate the efficacy, safety, and recurrence rates with polidocanol sclerotherapy in the treatment of pyogenic granulomas (PGs). METHODS AND METHODS: Thirty-nine patients with PG were injected with polidocanol 1% solution. Repeat injections were given weekly in case of incomplete clinical/dermoscopic resolution, until a maximum of 3 sittings. A higher strength (3%) was used for subsequent sessions in those with a minimal response to 1% solution. A final assessment for relapses was performed at 3, 6, and 12 months. RESULTS: All 39 patients achieved complete resolution (100% clearance rate), with most (n = 26) lesions resolving after the first sitting. Side effects noted were postprocedure pain (22), erythema (2), superficial ulceration (2), paresthesias (1), prominent edema (4), thrombophlebitis (1), cyanotic discoloration (1), purpuric staining around injection site (4), and mild local pruritus (1). The procedure was well tolerated across the age spectrum (4-63 years) included. CONCLUSION: We report polidocanol to be a highly effective, safe, and cost-effective sclerosant for treatment of PGs with no recurrences or need for special postprocedure care.

Establishing the efficacy and safety of the novel use of common salt for the treatment of pyogenic granuloma.

BACKGROUND: Recurrent bleeding episodes are often a cause of significant anxiety in patients with pyogenic granuloma (PG). The idea of using common salt for the treatment of PG arose from the need for a relatively safe and effective treatment because of the recurrent nature of the lesion. METHODS: A prospective open-label uncontrolled study of 50 patients was conducted. All cases were treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. All patients were followed up for any complications or recurrence. RESULTS: Complete resolution of the lesion without any residual scar was seen in 100% of the cases, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response. The mean time to complete resolution was 14.77 days. Recurrence was noted in one patient after 11 months of resolution. CONCLUSION: Owing to the relative ease in application, lack of scarring and excellent response, we consider salt application to be an ideal treatment for PG lesions, especially in children and anxious patients reluctant to undergo any procedure.

Polidocanol Sclerotherapy for the Treatment of Pyogenic Granuloma in Children.

BACKGROUND: Pyogenic granuloma (PG) is a benign vascular lesion that is commonly observed in the skin and mucosa. Sclerotherapy is the first-line conservative treatment option for PG. OBJECTIVE: This retrospective study aimed to evaluate the efficacy of sclerotherapy with 1.0% polidocanol for the treatment of PG. MATERIALS AND METHODS: All patients who were clinically diagnosed with PG consecutively at the Pediatric Outpatient Service of Qilu Children's Hospital of Shandong University from March 2018 to October 2019 received sclerotherapy with 1.0% polidocanol. RESULT: The procedure resulted in the complete excision of PG, with inconspicuous scars. The procedure was well-tolerated, and recurrence was not observed. Allergic reactions, cutaneous necrosis, and pigmentary changes were not observed. CONCLUSION: Sclerotherapy with 1.0% polidocanol is considered an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome.

Pediatric Tracheal Lobular Capillary Hemangioma: A Case Report and Review of the Literature.

Chronic cough is a common complaint in the pediatric population and can have many different etiologies. We present a rare case of a tracheal lobular capillary hemangioma (LCH), also known as pyogenic granuloma, causing chronic cough in a child. In this case, the tracheal LCH was managed successfully with laser ablation. A review of the literature reveals only 2 other reported pediatric cases of tracheal LCH. Laryngoscope, 131:1729-1731, 2021.

Doença periodontal como fator determinante para a recidiva do granuloma piogênico / Periodontal disease as a determining factor for piogenic granumola recurrence

O presente estudo tem como objetivo descrever por meio de um caso clínico o diagnóstico e a conduta clínica no tratamento de um Granuloma Piogênico (GP) recidivante associado à doença periodontal. O GP é uma lesão inflamatória hiperplásica que se encontra nos tecidos moles da cavidade bucal e que possui um crescimento reagente estimulado por irritação local de baixa intensidade, fator hormonal ou trauma, podendo causar desconforto ao paciente e interferir na fala e mastigação. O GP acomete principalmente mulheres na segunda e terceira décadas de vida em regiões como gengiva, lábios, língua e mucosa bucal. O tratamento do GP consiste em excisão cirúrgica e o diagnóstico decisivo é realizado por meio de exame histopatológico. Paciente do gênero feminino, 57 anos, procurou atendimento no Centro Universitário da Serra Gaúcha ­ FSG por apresentar lesão rósea pediculada na região de papila incisiva com cerca de 2 cm de diâmetro. A paciente foi submetida a dois procedimentos cirúrgicos e em ambos ocorreu a recidiva. A completa excisão da lesão somente foi realizada após realização de tratamento periodontal e remoção de fatores irritantes como biofilme e cálculo dentário. Desta forma, foi possível concluir que é de suma importância a observação e remoção dos fatores irritantes durante o tratamento do GP e que desta maneira se diminuiu as chances de posterior recidiva(AU)

The present study aims to describe through a clinical case the diagnosis and clinical management treatment of a recurrent Piogenic Granuloma (GP) associated with periodontal disease. PG is a hyperplastic inflammatory lesion found in the soft tissues of the oral cavity and has a reactive growth stimulated by low intensity local irritation, hormonal factor or trauma, which may cause patient discomfort and interfere with speech and chewing. GP affects mainly women in the second and third decades of life in regions such as gums, lips, tongue and oral mucosa. The treatment of GP consists of surgical excision and the decisive diagnosis is made by histopathological examination. Female patient, 57 years old, attended the University Center of Serra Gaúcha - FSG presenting pediculated pink lesion in the incisive papilla region with about 2 cm in diameter. The patient underwent two surgical procedures and both relapsed. Complete excision of the lesion was only performed after periodontal treatment and removal of irritating factors such as biofilm and dental calculus. Thus, it was possible to conclude that the observation and removal of irritating factors during the treatment of GP is of paramount importance and thus reduced the chances of further relapse(AU)

Intraoperative mitomycin C and cryotherapy as adjunct therapy for recurrent lobular capillary haemangioma of conjunctiva.

Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but sometimes it may be difficult to manage multiple recurrences. A 31-year-old female patient presented with recurrent polypoid conjunctival lobular capillary haemangioma. Excisional biopsy was performed, followed by eye drop mitomycin C 0.04% four times a day for 1 week postoperatively. She reported again after 3 months with recurrence of vascular elongated nodular lesion. Excision of the mass with application of mitomycin C 0.02% intraoperatively for 1 min and cryotherapy using double thaw technique of the peripheral conjunctival margin was done. The histopathological examination confirmed the recurrence of lobular capillary haemangioma. On review, 1 year after treatment there was no evidence of recurrence. A combined use of cryotherapy and intraoperative mitomycin C as adjunctive therapy after surgical excision can successfully prevent further recurrence without any adverse effect.

Use of a water-cooled Nd: YAG pulsed laser in the treatment of giant gingival pyogenic granulomas during pregnancy.

Pyogenic granuloma is a benign growth characterized by active vascular proliferation and is prone to occurring during pregnancy. Given the complicated conditions of this special group of patients, it is controversial to perform removal therapy before delivery. Here, two giant pregnancy pyogenic granulomas of a patient at 34 weeks gestation were safely, completely and minimally invasively removed by water-cooled Nd: YAG laser without anesthetic agents, suturing or antibiotics. No recurrence was observed after 1 year. This removal therapy immediately relieved the problem of patient nutrition intake and greatly improved the quality of her prenatal preparation. Thus, this report highlights that complete excision of pyogenic granulomas during pregnancy can be performed before delivery when urgent circumstances are considered, and a water-cooled Nd: YAG laser can be applied as a powerful tool in this treatment.

Clinical and Endoscopic Characteristics of Pyogenic Granuloma in the Small Intestine: A Case Series with Literature Review.

Pyogenic granuloma (PG) generally appears in the skin or oral cavity, but rarely occurs in the small intestine, where it can cause bleeding. To date, only 35 cases of small intestinal PG have been reported in the English literature. We retrospectively collected information from the clinical records of seven cases of small intestinal PG that were managed in our hospital and summarized the characteristics. Further information on the clinical characteristics was obtained from the literature. Capsule endoscopy, useful for identifying the source of hemorrhage in obscure gastrointestinal bleeding, can detect PGs. Treatment can often be accomplished with endoscopic mucosal resection.

[Pyogenic granuloma with satellitosis]. / Satellitenrezidiv bei Granuloma pyogenicum.

A 16-year-old female developed a satellite-like recurrence of a pyogenic granuloma on her thorax 2 weeks after complete excision. Treatment with a pulsed dye laser led to a complete resolution. BRAF and RAS mutations detected in the pyogenic granuloma are considered major driver mutations. Whether these findings are also of importance for the etiopathogenesis of satellitosis is unknown. In our patient, no BRAF or NRAS mutation could be detected.

What's New in Nail Disorders.

Various advancements in the diagnosis and management of nail diseases have transpired in recent years. To provide the best care for patients with nail complaints, it is essential that physicians be updated on new diagnostic and treatment modalities. The purpose of this article is to discuss new and oncoming diagnostic and management options for nail disorders, including nail psoriasis, retronychia, brittle nails, onychotillomania, trauma, trachyonychia, and pyogenic granulomas.

Therapeutic approaches to pyogenic granuloma: an updated review.

Pyogenic granuloma is a benign vascular proliferation of the skin and mucous membranes, whose pathogenesis is not fully understood. Despite its benign nature, it can have a significant negative impact on patients' quality of life, and therefore appropriate therapy is needed. Over the years, a lot of therapeutic modalities have been used in order to successfully treat this condition. This paper is an updated systematic overview of all the reported successful treatments described in the literature and was conducted according to the PRISMA guidelines for systematic reviews. Articles derived from the databases PubMed, EMBASE, and SCOPUS, published between 1981 and 2018, were analyzed for this study. In the literature, there are several studies, case series, and case reports that demonstrate encouraging results with the use of various methods, such as surgical intervention or laser treatment, but also with more conservative approaches, including the application of topical and systemic agents. The selection of the appropriate treatment should be made individually, depending on severity of the disease and patient characteristics. Both research efforts as well as clinical reporting are necessary in order to provide more insight on the management of these vascular tumors. This paper aims to provide a summarized update on the reported therapies and to raise awareness for the need to conduct larger systematic studies in order to adequately evaluate and compare the effectiveness of the presented therapeutic strategies.