Pyogenic granuloma: causes, complications, removal and folk treatment

A chronic, atypical, vegetative pathology – pyogenic granuloma – occurs in areas with a long-standing infection (usually staphylococcal). Thus, pyogenic granuloma is often found in the oral cavity, near the nail plates or fistulas.

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Epidemiology

Most often, pyogenic granulomas are found in boys, in the age period up to 3 years, and also from six to 15 years.

Granulomas are also found in 1-2% of cases in women during pregnancy or menopause, which is associated with dramatic hormonal changes in the body.

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Causes pyogenic granuloma

The exact reasons why a person may develop pyogenic granuloma have not yet been determined. Experts suggest that its development can be provoked by various infections, injuries, other diseases, or even excessively thorough body hygiene.

Approximately 25% of cases of pyogenic granuloma are associated with a violation of the integrity of the skin, with burns. There are cases when the disease was a consequence of a woman's long-term use of contraceptives or external use of certain medications.

There are external and internal risk factors, the presence of which increases the risk of pyogenic granuloma.

• External factors:
  • skin injuries;
  • complete failure to observe personal hygiene rules, or excessive observance of them;
  • disorders of the secretory activity of the skin.
• Internal factors:
  • infectious diseases;
  • digestive disorders;
  • endocrine disorders;
  • metabolic disorders;
  • stress, psychological trauma;
  • poisoning, including chronic;
  • immunodeficiency states, AIDS.

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Pathogenesis

Pyogenic granuloma can appear as a result of the influence of many reasons. Based on this, granulomas are conventionally divided into several categories:

• Infectious pyogenic granulomas develop against the background of various infections, such as tuberculosis, sexually transmitted infections, encephalitis, etc.
• Non-infectious pyogenic granulomas appear near fistulas, inflammatory elements, contaminated areas of the skin, etc.
• Pyogenic granulomas of unknown origin can be a consequence of almost any disease, but in most cases the reasons for their appearance cannot be determined.

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Symptoms pyogenic granuloma

The first signs of pyogenic granuloma appear approximately 15-20 days after exposure to the provoking factor. At first, the formation is not very large and is only a few millimeters in diameter. Some variants of pyogenic granuloma have a stalk, but can also be located in the form of a spot - round or oblong.

In the vast majority of cases, the granuloma has a cherry-red hue and looks like a dense elastic nodule, the borders of which are exfoliated epithelial tissue.

Pyogenic granuloma is most often not accompanied by pain: neither at rest nor when pressed.

The granuloma increases in size quite quickly: within 2-3 weeks its diameter can reach its limit.

The pyogenic formation can be easily damaged, and even cause bleeding or ulceration.

During examination, inflammation of the lymph nodes is not always detected, but only in the presence of a widespread infection.

In most cases, pyogenic granuloma forms as a single nodule. Multiple lesions are much less common.

• Can a pyogenic granuloma itch? Indeed, during the period of active growth, a granuloma can cause unpleasant sensations in the form of itching and a state of skin tension. After the growth of the neoplasm stops, the itching sensations should disappear.
• Pyogenic granuloma of the skin is most often localized on the upper limbs and especially on the fingers, as well as in the area of the face and feet. During pregnancy, granulomas can form in the oral cavity - on the gums or on the upper palate.
• Pyogenic granuloma of the left buccal region, as well as the right one, can occur under the influence of disturbed microflora, often as a consequence of chronic periodontitis. Such granuloma, as a rule, is located near the affected tooth (on the affected side), and is characterized by a sluggish and slow course. Treatment of such a neoplasm is only surgical.
• Pyogenic granuloma on the genitals in most cases has a venereal origin. Infection occurs during accidental unprotected sexual contact. In addition to granulomas, ulcers and nodules may form on the genitals. Sometimes nearby lymph nodes enlarge.
• Pyogenic granuloma on the leg is usually localized in the area of the foot or toes. The most common cause of such granuloma is mechanical damage to the skin. However, often, especially when the hips and knees are affected, the cause of the disease remains unclear.
• Pyogenic granuloma on the tongue occurs due to insufficient oral hygiene, or in women during pregnancy - due to hormonal imbalance. A similar problem - pyogenic granuloma of the gum - can be the result of improperly treated tooth or the presence of tartar. Such granulomas are removed by surgery, but to prevent the recurrence of the neoplasm, the cause of its appearance should be eradicated.
• Pyogenic granuloma on the head can be located on the eyelids, cheeks, nose, near the lips, and even on the ears. This problem is most often found in young people and teenagers. The reason is most likely hidden in hormonal changes associated with puberty. The problem may also be insufficient stress resistance and psycho-emotional imperfection of the nervous system.
• Pyogenic granuloma in children most often appears before the age of 3 – mainly as a result of injuries and skin damage. Such granulomas grow quickly and bleed. More than 70% of childhood granulomas are located on the face or neck.
• Pyogenic granuloma is found in 1-2% of women during pregnancy. Experts explain this by the presence of hormonal disorders, since granulomas appear mainly in the first half of pregnancy - during the period of significant fluctuations in the level of sex hormones. The most common localization of granulomas in pregnant patients is the oral cavity.

Stages

The mechanism of development of pyogenic granuloma has several stages:

1. Accumulation of a large number of monocytic phagocytes in the area of pathological formation.
2. Transformation of cellular structures into macrophages, formation of granuloma.
3. Transformation of phagocytes and macrophages into epithelioids with the formation of epithelioid pyogenic formation.
4. Combination of macrophages with granuloma formation.

Taking into account the course of metabolic processes, pyogenic granulomas with low and accelerated metabolism are distinguished:

• granulomas with low-intensity metabolism develop as a result of the influence of inert substances (foreign bodies);
• Granulomas with accelerated metabolism occur under the influence of toxic factors (tuberculosis, leprosy, intoxication, etc.).

Pyogenic granuloma, botryomycoma - these are equivalent terms that denote the same disease. Therefore, the doctor may use one or the other name when making a diagnosis.

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Complications and consequences

Pyogenic granuloma is a potential source of infection, as well as a tumor formation that can be complicated by proliferation, spread to other parts of the body, and inflammation.

Complications can negatively affect the functionality of other organs and systems.

If the cause of pyogenic granuloma is not initially determined, the disease can recur again and again, causing not only aesthetic but also functional problems.

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Diagnostics pyogenic granuloma

Detecting a pyogenic granuloma should not be a problem for an experienced physician. Sometimes the doctor does not even need to perform additional examination of the patient.

However, there are cases when auxiliary diagnostic procedures are indispensable. Such cases include those in which it is difficult to determine the underlying cause of the disease.

First of all, you may need to consult with various specialists - this could be a surgeon, dermatologist, venereologist, dentist - depending on which part of the body the pyogenic formation appeared on.

Next, laboratory and microbiological tests are prescribed:

• Blood and urine tests will help to identify underlying diseases and complications;
• Microbiological studies (serology, PCR, culture studies) will help to identify the causative agent of infectious pathology.

For the correct further use of antibiotics, the doctor may prescribe an antibiogram.

Instrumental diagnostics:

• ultrasound diagnostics to exclude diseases of internal organs;
• angiography to check the condition of blood vessels;
• magnetic resonance imaging or computed tomography to rule out diseases of the joints and spine;
• X-ray to rule out tuberculosis of the lungs.

In addition, in many cases it is necessary to conduct a histological examination to distinguish pyogenic granuloma from a malignant tumor.

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Differential diagnosis

Differential diagnosis includes amelanotic melanoma, glomus neoplasm, hemangiomas, squamous cell carcinoma, basal cell carcinoma, warts, bacillary angiomatosis, Kaposi's sarcoma and cutaneous cancer metastases.

Pyogenic granuloma and non-pigmented melanoma also require differentiation:

• pyogenic granuloma often has a stalk, which is not typical for melanoma;
• the granuloma has a deep red tint (in extreme cases, bluish), but it cannot be colorless or black, like malignant melanoma;
• pyogenic granuloma begins to bleed even with slight touch;
• Pyogenic granuloma grows very quickly, which is not considered typical for melanoma.

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Treatment pyogenic granuloma

Treatment procedures and prescriptions for pyogenic granuloma are selected based on the causes of the disease.

If the cause of the granuloma is an infection, the patient will be prescribed a course of antibiotic therapy.

In immunodeficiency states, it is necessary to resort to anti-inflammatory and/or hormonal treatment.

If pyogenic granuloma occurs in the oral cavity, then in most cases surgical treatment of the problem is prescribed.

Medicines for pyogenic granuloma are always prescribed, but complete cure of the disease is not always guaranteed. The outcome of treatment depends, first of all, on whether the cause of the neoplasm has been eliminated. If such a cause remains unknown, then sometimes it is not possible to eliminate it.

The main medications that are relevant for a disease such as pyogenic granuloma are the following:

• Nonsteroidal anti-inflammatory drugs are designed to block further development of granuloma and relieve unpleasant symptoms of the disease. For example, a drug such as Celecoxib is often prescribed - this drug does not have a negative effect on the digestive system, but it eliminates pain and inflammation well. Celecoxib is taken 100-200 mg daily, in one or two doses.
• Antibiotics are prescribed for pyogenic granulomas of infectious origin. The drug of choice is often Ciprofloxacin (orally 750 mg 2 times a day) or Gentamicin (intramuscularly 1 mg per kg of weight, three times a day).
• Antifungal agents are not used often, but only in cases of confirmed fungal etiology of granuloma. Of the antifungal agents, Fluconazole is usually used - 200-400 mg per day.
• Hormonal anti-inflammatory drugs can be used in immunodeficiency conditions. For example, in such cases, Sinaflan ointment may be needed - it is applied 1-3 times a day, lightly rubbing into the affected area. Hormonal ointments are not recommended for long-term use, as this can cause the skin to become "addicted".
• Cytostatic drugs are antitumor agents that inhibit cell growth. Such drugs are prescribed only when the disease takes a malignant course, or in cases where the mechanism of development of a specific pyogenic granuloma is not fully understood.

In addition to the medications we have listed, the attending physician may also prescribe general strengthening and immunomodulatory treatment, which includes vitamins and other means that stimulate the immune system. Such medications do not have a direct effect on the disappearance of pyogenic granuloma. However, their use allows you to avoid complications and strengthen the body's immune response to the invasion of infection.

Among such drugs, the following can be particularly distinguished:

• Aevit;
• Complivit;
• Vitrum beauty;
• Echinacea extract.

Physiotherapy has proven itself to be a good option in a comprehensive approach to treating pyogenic granuloma. The doctor often prescribes the following procedures:

• UFO treatment;
• heliotherapy;
• UHF;
• ultrasound;
• electrophoresis;
• phonophoresis;
• laser therapy.

Physiotherapy is used only when the benign course of the granuloma is confirmed by diagnostics.

Folk remedies

The use of alternative medicine for pyogenic granuloma must be agreed with a doctor in order not to cause irreparable harm to health. If unpleasant symptoms appear (pain, inflammation, swelling), you can use the following folk remedies:

• Propolis tincture can be bought at a pharmacy or prepared independently (30 g of propolis is infused for 10 days in 200 ml of vodka). For granuloma, a cotton pad is soaked in the infusion and applied to the affected area.
• Garlic tincture is prepared at the rate of 10 g of crushed garlic per 50 ml of vodka. The tincture is kept for two weeks in a dark place, occasionally stirring the contents. For granuloma, the tincture is diluted 1:1 and used for compresses.
• For inflamed granulomas, it is recommended to apply compresses of raw potato juice.
• In case of pain, the granuloma is washed with fresh onion juice.

It is worth noting that when using the listed methods or other folk methods, the granuloma itself will not disappear. We are only talking about alleviating the symptoms of the disease and slowing down the growth of the neoplasm. It is possible to completely get rid of pyogenic granuloma only by medical methods.

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Herbal treatment

For infectious pyogenic granuloma, herbal treatment may help:

• Aloe infusion is prepared as follows: the top leaves are cut as finely as possible, and the juice is squeezed out of them. Mix 50 ml of juice, 100 g of honey and 150 g of red fortified wine. The medicine is infused for 3-4 days in the refrigerator. Take 1 tbsp. before meals.
• Motherwort infusion is prepared like tea. Drink 100 ml 2-3 times a day.
• Dressings are made using St. John's wort oil or Kalanchoe ointment.
• Infusions and decoctions of herbs such as plantain, aloe, sea buckthorn, succession, chamomile, St. John's wort, sage, arnica, and calendula are taken internally.
• To prevent recurrence of granuloma, it is recommended to take Eleutherococcus extract or Saparal - 30 drops twice a day for 2-4 weeks.

Homeopathy

Taking homeopathic remedies has virtually no contraindications - except for a possible allergy to the drug. Such medications are prescribed by a homeopathic doctor on an individual basis, since according to the principle of homeopathy, it is necessary to act on the cause, and not on the manifestations of the disease.

For granulomas, Causticum, Thuja, Graphitis, and Barium carbonicum are indicated.

For bleeding, use Acidum nitricum and Thuja.

If the staphylococcal nature of pyogenic granuloma is diagnosed, then in the early stages of the disease the patient is offered Apis, Lachesis, Belladonna.

To support the body's immune defense, drugs such as Crotalus, Hepar sulfur, and Sulfur iodatum are suitable.

Removal of pyogenic granuloma

Not all types of pyogenic granulomas have to be treated surgically. For example, neoplasms of an infectious nature, or those that arose as a result of autoimmune reactions, are pointless to remove, since they will inevitably recur.

Pyogenic granulomas are not removed in the following cases:

• if there are many granulomas and they grow quickly;
• if there is a high risk of granuloma recurrence;
• if there is a risk of spreading infectious agents from the outbreak;
• if the granuloma grows from the deep layers;
• if there is a risk of complications from surgical removal of the neoplasm;
• if pyogenic granuloma can be eliminated by conservative treatment.

Most often, removal is prescribed for pyogenic neoplasms in the oral cavity.

Laser removal of pyogenic granuloma is currently considered the highest quality and most gentle type of surgery in this area. Laser beams can clearly affect the neoplasm without damaging healthy nearby tissue. Superficial vascular tumors are often removed in this way: the risk of bleeding is eliminated during the operation, and healing is extremely fast and painless.

Laser removal is not used only if the size of the pyogenic granuloma exceeds 15-20 mm in diameter. In such a situation, the doctor can remove the neoplasm by conventional surgical intervention.

Prevention

The list of preventive measures to prevent the development of pyogenic granuloma consists of general recommendations for a healthy lifestyle and strengthening the body's defenses. In addition, it is very important to undergo regular examinations by medical specialists - especially a dentist, gynecologist (for women) and proctologist (for men).

It is recommended to consult a doctor if there are difficult-to-heal wounds on the body.

It is also necessary to pay attention to protection during casual sexual intercourse in order to avoid contracting sexually transmitted diseases.

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Forecast

The prognosis for pyogenic granulomas can be called favorable. If the patient seeks medical help in a timely manner and follows all the doctor's recommendations, the problem can be resolved positively in most cases.

A granuloma in the oral cavity is usually removed surgically, often along with the diseased tooth.

Cutaneous pyogenic lesions can usually be eliminated with conservative treatment.

The most unfavorable prognosis is associated with pyogenic granuloma with an unknown cause and mechanism of development.

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