Granuloma, Pyogenic

Description

• Pyogenic granulomas (PG) are benign vascular proliferations that appear most commonly on the skin and mucus membranes. Most common sites are the head and neck, the lips and oral cavity, the trunk, and the extremities (1),(2).
• Described as rapidly growing erythematous to violaceous nodules that develop into pedunculated masses with erosive surface that are friable and tend to bleed profusely due to the vascular nature of the lesion
• Less commonly presents as a sessile lesion
• Rarely regress completely without intervention (2)
• Synonym(s): lobular capillary hemangioma, granuloma telangiectaticum, granuloma gravidarum

Epidemiology

• The peak incidence of PG occurs in children and young adults (2).
• Commonly seen in early pregnancy
• Conflicting evidence from prior studies regarding male or female predominance; overall, seems to have a male predominance in childhood through adolescence and female predominance during reproductive years before the age of 40 years

Prevalence

• Up to 1 in 25,000 adults are diagnosed with an intraoral PG in their lifetime (2).
• Cutaneous pyogenic granulomas account for 0.5% of childhood skin nodules (2).

Etiology and Pathophysiology

• Definitive cause unknown
• Thought to be associated with capillary proliferation resulting from aberrant healing response to minor trauma
• Associated with peripheral nerve injury, inflammatory systemic diseases, and drugs (retinoids, systemic steroids, protease inhibitors, epidermal growth factor receptor inhibitors)
• May be related to hormonal changes in pregnancy
• Not considered a hemangioma or neoplasm; no true granulomatous histology present

Risk Factors

• Pregnancy
• Trauma
• Intraoral trauma or surgery
• Inflammatory systemic diseases
• Medications such as retinoids, systemic steroids, protease inhibitors, epidermal growth factor receptor inhibitors

General Prevention

Good oral hygiene may be helpful.

Commonly Associated Conditions

Inflammatory systemic diseases