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Clinical Summary

Pyogenic granuloma presents as an eruptive, friable papule over weeks. They are frequently located on the extremities, face, or at recently traumatized sites. Children are commonly affected, but they can occur at any age. The lesion will bleed with little trauma and can be difficult to stop. If the papule is not completely removed, it will likely recur at the same site. Pregnant women have a higher incidence of pyogenic granulomas (common on the gingiva).

Management and Disposition

Most ED presentations of pyogenic granuloma will be due to prolonged, often brisk, bleeding. Silver nitrate applied to the papule base is usually effective (avoid on the face to prevent permanent staining). Refer patients to a dermatologist for possible biopsy and further treatment.

Pearls

  1. An association with isotretinoin, indinavir, epidermal growth factor receptor inhibitors, and capecitabine has been described.

  2. Approximately one-third of these benign lesions follow some form of minor trauma.

  3. Refer patients for biopsy and histology to exclude other vascular tumors or melanoma.

FIGURE 13.106

Pyogenic Granuloma. Note the violaceous color and multilobulated nodule. The hyperpigmented patches on either side are secondary to a bandage. (Photo contributor: J. Matthew Hardin, MD.)

FIGURE 13.107

Pyogenic Granuloma. A moist, violaceous, vascular nodule formed at the site of an injury. Note that the nodule is demarcated by a thin rim of friable epidermis. (Photo contributor: J. Matthew Hardin, MD.)

FIGURE 13.108

Pyogenic Granuloma. Friable papule with frequent bleeding. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 13.109

Pyogenic Granuloma. Note the violaceous color and multilobulated nodule. (Photo contributor: J. Matthew Hardin, MD.)

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