Pyogenic granuloma is a benign skin tumor that develops from embryonic cells of blood vessels. It often grows very rapidly, but always remains limited. It also often forms during pregnancy as a pregnancy tumor in the oral cavity.
What is pyogenic granuloma?
Pyogenic granuloma represents a benign growth of vascular cells in the skin. Often, the growth is misdiagnosed with malignant degeneration. However, the tumor remains sharply circumscribed and does not metastasize. Even without treatment, the prognosis is good. The tumor appears red and has a raspberry-like appearance. Colloquially, pyogenic granuloma is also called a blood sponge. The reddish appearance is caused by the large number of newly formed blood vessels. Since the growths involve vascular cells, even the term pyogenic granuloma is actually scientifically incorrect. The term “pyogenic” means pus-forming. A granuloma normally involves immune cells. Since neither pus is formed nor immune cells are involved here, the term pyogenic granuloma is based on a misnomer. Therefore, the tumor is also called lobular capillary hemangioma by many authors. Thus, the disease belongs to the group of hemangiomas. Women and men of all ages can be affected. In fair-skinned people, the hemangioma occurs up to 86.4 percent. Very often it occurs in the oral cavity during pregnancy.
Causes
The causes of pyogenic granuloma are not yet clear. A hemangioma is an embryonal tumor that develops by profiling embryonal cells. Usually, hemangiomas mainly affect children and young people. However, specifically pyogenic granulomas can also occur in all age groups. It was found that embryonic vascular wall cells behave like placental tissue. Their growth is self-limiting. Which pathomechanisms lead to the formation of pyogenic granuloma is not yet known. However, its increased occurrence during pregnancy has been observed. The so-called pregnancy tumor develops exclusively in the oral cavity. It occurs especially in patients with simultaneous inflammatory processes in the gum area. The interaction of pregnancy hormones and infectious processes in the oral cavity is suspected. After pregnancy, pregnancy tumors spontaneously regress. Pyogenic granulomas may also develop outside pregnancy in both men and women. Their formation is often preceded by traumatic injuries, hormonal changes, or the use of certain medications. Even small insect bites can trigger a hematoma. Even in second-degree burns, pyogenic granulomas often develop at the affected site years later. Malformations of blood vessels, such as port-wine stains, also favor the development of hematopoieses.
Symptoms, complaints, and signs
Pyogenic granuloma appears as a small red nodule that spreads rapidly by growth. Tumors can reach a diameter of 10 to 30 millimeters. Growth is limited. The demarcation from the remaining tissue also remains sharp. Usually, only a single tumor is observed. In rare cases, multiple satellite tumors occur. Pyogenic granuloma has a tendency to bleed and ooze. In this process, the surface becomes crusted. Later, there is a tendency to ulceration. However, pain does not occur at any time. Most often, the tumor is found in the head and neck area and on the mucous membranes of the nose and mouth. Thus, the lips, scalp, face and tongue are frequently affected. Hemangiomas can also occur on the palm, toes or even penis. The pregnancy tumor, on the other hand, is found only in the oral cavity. In rare cases, internal organs such as the liver, intestines, esophagus or stomach are also affected. Once formed, pyogenic granuloma usually does not regress on its own. Again, the pregnancy tumor is an exception. No complications are usually expected with pyogenic granuloma. The prognosis is good. It does not degenerate. However, in extreme cases, degeneration of the nasal skeleton and paranasal sinuses may still occur.
Diagnosis and course of the disease
Pyogenic granuloma is very easy to diagnose by eye.However, it is often difficult to differentiate it from dangerous diseases such as malignant melanomas, hemangiosarcomas or squamous cell carcinomas. However, appropriate histological examinations then provide certainty.
Complications
In about half of patients, pyogenic granuloma regrows after removal. As a result, there may be sensitive nerve damage and skin changes in the area around the tumor. The development of scars is also possible. If the granuloma remains untreated, bleeding and infections may occur, which in turn are associated with complications. Thus, severe inflammation may develop in the tissue, sometimes leading to numbness or severe pain. The tumor can also press on nerve and muscle cords and cause multiform deficits. In extreme cases, serious circulatory disorders occur in the affected part of the body. Major complications are relatively unlikely when treating a pyogenic granuloma. However, the surgical procedure carries the risk of bleeding and post-operative hemorrhage. If the tumor is treated with silver nitrate, appropriate side effects (swelling, inflammation, redness, itching) and cosmetic changes may occur. Cryosurgery may cause wound healing disorders, pus formation and local frostbite. There is also a risk of permanent tissue disruption. Laser treatment of pyogenic granuloma may rarely cause burns and blistering and scarring. The alteration of chemical tissue structures may cause long-term discomfort.
When should you see a doctor?
Since this condition is a tumor, it should always be treated by a doctor. Treatment by means of self-help cannot be carried out. The earlier the tumor is detected, the higher the probability of complete recovery. A doctor should be consulted if the affected person discovers an ulcer on his body. This usually occurs in the area of the neck and head. In women, a tumor may develop in the area of the oral cavity during pregnancy, while in men, a tumor may also develop on the penis. In most cases, the tumor can be treated and removed relatively well, so there are no particular complications. The treatment then takes place at the respective specialist and depends very much on the affected region. The initial diagnosis can be made by a general practitioner.
Treatment and therapy
Treatment of pyogenic granuloma usually leads to complete healing. In the case of a pregnancy tumor, therapy is not necessary at all, because in this case the hemangioma disappears on its own. In most other cases, the tumor can only be removed by surgery. This is done either by cutting it out or by laser ablation. In this case, the central blood vessel supplying the tumor must be completely removed. Otherwise, recurrences would form immediately, reaching the same size again a few days after surgery. The surgical procedure can be performed under local anesthesia in adults and under general anesthesia in children. In the past, good experience has also been made with cryosurgery. As an alternative, the application of chemicals such as silver nitrate to the pyogenic granuloma is also an option. Bleeding can be stopped in this way.
Prevention
Because the cause of pyogenic granuloma is unknown, no general recommendation can be made for its prevention. Only the probability of the pregnancy tumor can be reduced. Since inflammatory processes in the oral cavity during pregnancy favor pyogenic granuloma, intensive oral hygiene can reduce the risk of its onset.
Follow-up
After successful treatment of pyogenic granuloma, no follow-up treatments are required because the disease does not result in any adverse health consequences. Because the causes of pyogenic granuloma have not yet been definitively determined, follow-up treatments tailored to the cause cannot be given. It is true that some drugs (antibiotics) are suspected of promoting the development of pyogenic granuloma. However, this could not be proven in previous studies. In addition, the benefits and risks associated with the use of these drugs must be weighed, which makes it inadvisable to abandon them altogether.However, there are certainly things that can be observed to reduce the likelihood of a pyogenic granuloma developing again. The risk of developing a pyogenic granuloma is generally increased in persons who have already contracted one. Intensive skin and body hygiene is recommended to prevent the development of a new pyogenic granuloma. Since injuries and burns are suspected of promoting the formation of a pyogenic granuloma, these should be avoided. In addition, the scars left after treatment of a pyogenic granuloma can often develop into unsightly areas on the skin. Therefore, to positively influence scar development, it is recommended to regularly apply scar gel and/or scar ointment to the scar.
