Granuloma, Pyogenic

Description

• Pyogenic granulomas (PGs) are benign vascular proliferations that appear most commonly on the skin and mucous membranes as rapidly growing erythematous to violaceous nodules that develop into pedunculated masses with an erosive surface that is friable and tends to bleed profusely due to the vascular nature of the lesion.
• Most common sites are the head, neck, lips, oral cavity, trunk, and extremities (1).
• Less commonly presents as a sessile lesion
• Rarely regress completely without intervention (1)
• Synonyms: lobular capillary hemangioma, granuloma telangiectaticum, granuloma gravidarum

Epidemiology

• The peak incidence of PG occurs in children and young adults (1).
• Commonly seen in early pregnancy
• Male predominance in childhood through adolescence and female predominance during reproductive years before age 50 years

Etiology and Pathophysiology

• Definitive cause remains under investigation.
• Initially thought to be associated with capillary proliferation resulting from aberrant healing response to minor trauma
• More recent studies are showing involvement in oncogenic mutations of the MAPK pathway and showing no left to right laterality bias challenging the trauma-induced hypothesis.
• Some medications are associated with higher risk of development such as retinoids, progesterone and estrogen, protease inhibitors, and antineoplastics such as epidermal growth factor receptor inhibitors.
• Likely also related to hormonal changes in pregnancy by inducing swelling of endothelial cells, releasing vasoactive mediators from damaged mast cells, and increasing vascular permeability
• Not considered a hemangioma or neoplasm; no true granulomatous histology present. Instead, PGs manifest as plump endothelial cells with significant mitotic activity.

Risk Factors

• Pregnancy
• Possibly trauma
• Inflammatory systemic diseases
• Medications such as retinoids, hormone therapy containing progesterone or estrogen, protease inhibitors, and neoplastics such as epidermal growth factor receptor inhibitors

General Prevention

Good oral hygiene may be helpful. Avoid medications implicated in increased risk where possible.

Commonly Associated Conditions

• Pregnancy—common
• Cancer with antineoplastic treatment—common
• Inflammatory dermatoses or inflammatory systemic diseases—rare