Granuloma Pyogenicum - Alles Wat Je Moet Weten Over Deze Huidziekte

Tratamiento del granuloma piógeno

El tratamiento del granuloma piógeno es la excisión quirúrgica de la lesión. Normalmente se asocia a la intervención quirúrgica que se utiliza para solucionar el problema de la uña encarnada. La técnica más utilizada es la técnica de Fenol-Alcohol que consiste en aplicar ácido fénico en los bordes ungueales, una vez retirados éstos. Esta técnica consigue un buen resultado estético y un postoperatorio indoloro, que permite al paciente incorporarse rápidamente a su vida normal. En el caso de existir el granuloma piógeno se añade la excisión del granuloma mediante bisturí. La lesión es remitida a estudio anatomopatológico para su diagnóstico exacto.

También se puede emplear la electrocoagulación o el nitrato de plata para intentar la reducción o eliminación del mismo.

Evaluation

Lobular capillary hemangioma is usually a clinical diagnosis based on history and classical clinical findings. The history should include inquiries into previous trauma, association with pregnancy, and a thorough review of medications. In some instances, a dermoscopic examination is valuable. Lesions show a pink or red homogenous papule with a scaly, white "collarette."[53] Occasionally, white lines that intersect may be seen and represent fibrous septa.[53] A histologic examination is warranted if a diagnosis cannot be achieved on clinical grounds. Some may choose to excise these lesions to alleviate patient anxiety rather than diagnostic uncertainty. Irrespective of the deciding factor for excision, it is strongly recommended that the tissue is sent for histopathologic confirmation to rule out any other sinister lesions.

Medical management is generally not recommended. A variety of topical or intralesional treatments have been used with variable responses. These include topical imiquimod cream, alitretinoin gel, timolol, propranolol, and even phenols for periungual lesions.[61][62][63][64][65] Intralesional therapy with corticosteroids and sclerosants such as ethanolamine oleate, sodium tetradecyl sulfate, polidocanol, and bleomycin have shown sporadic patient benefits.[66][67][68][69][70] In cases of pregnancy or medication-induced lobular capillary hemangiomas, the recurrence rate after treatment is higher. Medication should be discontinued if possible. For patients on antineoplastic medications, where stopping the medication is not possible, management is symptomatic. For example, in the case of epidermal growth factor receptor inhibitor-related lesions, the Multinational Association for Supportive Care in Cancer (MASCC) Skin Toxicity Study Group has published guidelines preventing and treating lobular capillary hemangiomas, recommending weekly chemical cauterization, electrodesiccation, or nail avulsion.[71]

DISCUSSION

Pyogenic granuloma is a common lesion in the skin and oral mucosa, but rarely found in the alimentary tract.3 Only 42 cases of pyogenic granuloma in the alimentary tract have been reported to date, the granuloma was located in the esophagus in 23 of these cases.2-6 The incidence rate is the same regardless of the gender and age of the patient.4 Currently, the etiologic factors suggested for pyogenic granuloma are infection, mechanical trauma, chemical irritation, pregnancy, and hormonal mechanisms that induce reactive inflammatory and abnormal vascular response.7,8 However, the exact etiology is still unknown. Thirty percent of the patients with esophageal pyogenic granulomas are asymptomatic and the remainder experience diverse symptoms such as dysphagia, epigastric discomfort, and soreness.5

On endoscopic analysis, such granulomas are seen as protruding tumors or occasionally as submucosal tumor-like lesions. Their diameters are less than 20 mm, and they are pale pink to dark red in color.4 The surface of these lesions were usually soft and were sometimes accompanied by exudates.

Our patients had submucosal tumor-like lesions, and therefore, we performed EUS. EUS findings for pyogenic granuloma have not yet been reported. EUS showed that the patients had lesions that were homogeneously hyperechogenic, had clear borders, and were located in the lamina propria or submucosa. It is thought that the hyperechogenicity reflects the proliferation of blood vessels in lesions like hemangiomas.9 These EUS features would be helpful in the differential diagnosis of esophageal submucosal tumor-like lesions, such as gastrointestinal stromal tumor, leiomyoma, lipoma, granular tumor, and duplication cyst. In case 2, bleeding occurred by forceps biopsy and then epinephrine was injected to stop the bleeding. Since pyogenic granuloma is a highly vascular lesion, massive bleeding is expected after biopsy. Therefore, if there is a possibility of pyogenic granuloma in esophageal submucosal tumor-like lesions by the above mentioned EUS findings, we could avoid endoscopic biopsy for histological diagnosis.

Bleeding

The papule is often easy to break. This can cause bleeding from the growth. Bleeding is a common symptom of pyogenic granulomas.

Children are more likely to have pyogenic granulomas on their neck or head. Less commonly, they may develop on their trunk or extremities.

When a pyogenic granuloma develops in a mucous membrane, common areas include the:

• lips
• gums
• tongue
• membrane covering the eye
• nasal passages
• vagina
• cervix

In pregnant people, the growths more commonly occur on the inner cheeks and gums.

The exact cause of pyogenic granulomas is unclear.

For some people, they may develop after a minor injury or damage to the skin. This may be because skin injury causes a rapid creation of capillaries and other tissues necessary to repair the damage.

Hormones may also play a role in the development of pyogenic granulomas. Estrogen and other sex hormones may lead to pyogenic granulomas during pregnancy.

Certain medications may also cause pyogenic granulomas to occur. Examples include:

• antiretrovirals, which are HIV medications
• systemic and topical retinoids
• immunosuppressive agents, such as tumor necrosis factor-alpha (TNF-alpha) antagonists
• antineoplastics

Other possible causes include:

To assist in reaching an accurate diagnosis, a doctor will usually perform a physical exam and ask questions about symptoms.

During the examination, they may look for certain clinical markings on the growths.

For some people, they may remove a sample from the lesions and send it to a lab. This can help confirm the diagnosis and rule out other possible causes.

Treatment often consists of either complete removal or shaving the growth off. Complete removal has a lower rate of recurrence compared with shaving it off.

Healthcare professionals may recommend shaving the growth followed by laser treatment for growths in sensitive areas or for pyogenic granulomas in children.