Pyogenic granuloma: causes, complications, removal and alternative treatment

Chronic, atypical, vegetative pathology - pyogenic granuloma - occurs on sites with a long-term infection (usually staphylococcal). So, the pyogenic granuloma is often found in the oral cavity, near the nail plates or fistulas.

[1], [2], [3]

Epidemiology

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

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

[4], [5], [6], [7]

Causes of the pyogenic granuloma

The exact reasons why a person may have pyogenic granuloma, have not yet been determined. Specialists suggest that various infections, traumas, other diseases, or even excessively careful body hygiene can provoke its development.

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 the result of prolonged intake of a contraceptive by a woman, or external use of certain medications.

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

• External factors:
  • skin trauma;
  • full non-observance of personal hygiene rules, or excessive compliance with them;
  • disorders of secretory activity of the skin.
• Internal factors:
  • infectious diseases;
  • disorders of the digestive system;
  • endocrine disorders;
  • metabolic disorders;
  • stress, psychotrauma;
  • poisoning, including chronic;
  • state of immunodeficiency, AIDS.

[8], [9], [10], [11], [12], [13]

Pathogenesis

Pyogenic granuloma can appear as a result of a variety of causes. Proceeding from this, granulomas are conditionally divided into several categories:

• Infectious pyogenic granulomas develop against a background of various infections, such as tuberculosis, sex infections, encephalitis, etc.
• Noninfectious pyogenic granulomas appear near the fistula, inflammatory elements, contaminated skin areas, etc.
• Pyogenic granulomas of unknown origin can be the result of almost any disease, but in most cases, the causes of their occurrence can not be established.

[14], [15], [16], [17], [18]

Symptoms of the pyogenic granuloma

The first signs of pyogenic granuloma appear about 15-20 days after the impact of the provoking factor. At first, education does not differ in size and has only a few millimeters in diameter. Some variants of the pyogenic granuloma have a leg, but can also be located in the form of a spot - round or oblong.

In most cases, the granuloma has a cherry-red hue and looks like a dense elastic knot, the boundaries of which are exfoliated epithelial tissue.

Pyogenic granuloma is most often not accompanied by pain: neither at rest nor with pressure.

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

Pyogenic formation can easily be damaged, and even cause bleeding or the formation of sores.

On examination, inflammation of the lymph nodes is not always found, but only in the presence of a common infection.

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

• Pyogenic granuloma can itch? Indeed, during a period of active growth, the granuloma can cause unpleasant sensations in the form of itching and skin tightness. After stopping the growth of the neoplasm, 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 face and feet. In pregnancy, granulomas can form in the oral cavity - on the gums or on the upper sky.
• The pyogenic granuloma of the left buccal region, as well as the right one, may arise under the influence of impaired microflora, often as a consequence of chronic periodontitis. Such a granuloma, as a rule, is located near the affected tooth (from the side of the lesion), and is characterized by a sluggish and slow course. Treatment of such a neoplasm is only surgical.
• Piogenic granuloma on the genitals in most cases has a venereal origin. Infection occurs with accidental unprotected sex. In addition to granulomas, ulcers and nodules can form on the genitals. Sometimes close lymph nodes are enlarged.
• Pyogenic granuloma on the leg is usually located in the area of the foot or fingers. The most common reason for the appearance of such a granuloma is mechanical damage to the skin. However, often, especially with the defeat of the hip and knee area, the cause of the disease remains unclarified.
• Pyogenic granuloma in the tongue arises when there is insufficient care for the oral cavity, or in women during pregnancy - due to a violation of the hormonal balance. A similar problem - pyogenic granuloma of the gums - may be the result of an improperly treated tooth, or the presence of tartar. Such granulomas are removed by surgery, but to prevent the re-development of the tumor, the cause of its appearance should be eradicated.
• The granuloma pyogenic on the head can be located on the eyelids, cheeks, on the nose, near the lips, and even on the ears. This problem is most common in young people and adolescents. The reason, most likely, lies in the hormonal changes associated with the period of puberty. Also, the problem may be lack of stress resistance and psychoemotional imperfection of the nervous system.
• Piogennaya granuloma in children is most often manifested before the 3rd year of age - mainly as a result of injuries and skin damage. Such granulomas quickly grow and bleed. More than 70% of children's granulomas are located on the face or neck.
• Piogenic granuloma during pregnancy is found in 1-2% of women. Experts explain this by the presence of hormonal disorders, since granulomas appear mainly in the first half of pregnancy - during a period of significant fluctuations in the level of sex hormones. The most frequent localization of granulomas in pregnant patients is oral cavity.

Stages

The mechanism of development of the pyogenic granuloma follows several stages:

1. The accumulation in the zone of pathological formation of a large number of monocytic phagocytes.
2. Transformation of cellular structures into macrophages, the formation of granulomas.
3. Transformation of phagocytes and macrophages into epithelioids with the formation of epithelioid pyogenic formation.
4. Combination of macrophages with the formation of granulomas.

Taking into account the course of metabolic processes, pyogenous granulomas differ with small and accelerated metabolism:

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

Pyogenic granuloma, botryomycom are equivalent terms that denote the same disease. Therefore, the doctor can use a particular name when making a diagnosis.

[19], [20], [21], [22]

Complications and consequences

Pyogenic granuloma is a potential source of infection, as well as tumor formation, which can be complicated by growth, spreading to other parts of the body, inflammation.

Complications can adversely affect the performance of other organs and systems.

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

[23], [24], [25], [26], [27], [28], [29], [30], [31]

Diagnostics of the pyogenic granuloma

To detect pyogenic granuloma for an experienced doctor should not be a problem. Sometimes the doctor does not even need to resort to an additional examination of the patient.

But nevertheless there are cases when it is not necessary to do without auxiliary diagnostic procedures. These cases include those in which it is difficult to determine the root cause of the disease.

First and foremost, consultation of various specialists may be required - it can be a surgeon, a dermatologist, a venereologist, a dentist - depending on which part of the body the pyogenic formation appeared on.

Further, laboratory and microbiological studies are prescribed:

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

For the competent further use of antibiotics, the doctor may prescribe an antibioticogram.

Instrumental diagnostics:

• ultrasound diagnosis for the exclusion of diseases of internal organs;
• angiography to check the condition of blood vessels;
• magnetic resonance imaging or computed tomography to exclude joint and spinal column diseases;
• X-ray to exclude tuberculosis of the lungs.

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

[32], [33], [34], [35]

Differential diagnosis

Differential diagnosis is carried out with amelanotic melanoma, glomus tumors, hemangiomas, a squamous cancer, a basal cell carcinoma, warts, bacillary angiomatosis, Kaposi's sarcoma and metastatic cutaneous cancer.

Pyogenic granuloma and non-pigment melanoma are also subject to differentiation:

• The pyogenic granuloma often has a foot, which is not characteristic of melanoma;
• Granuloma has a rich red color (in extreme cases - bluish), but it can not be colorless, or black, like malignant melanoma;
• The pyogenic granuloma begins to bleed even with a slight touch;
• The pyogenic granuloma grows very rapidly, which is not considered typical of melanoma.

[36], [37], [38],

Treatment of the pyogenic granuloma

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

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

When immunodeficiency states have resorted to anti-inflammatory and / or hormonal treatment.

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

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

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

• Nonsteroidal anti-inflammatory drugs are designed to block the further development of granuloma and alleviate the unpleasant signs of the disease. For example, a drug such as celecoxib is often prescribed - this drug does not adversely affect the digestive system, but it does well to remove pain and inflammation. Celecoxib is taken 100-200 mg daily, for one or two doses.
• Antibiotics are prescribed for pyogenic granulomas of infectious nature. The drug of choice is often Ciprofloxacin (inside 750 mg twice a day) or Gentamicin (intramuscularly at 1 mg per kg of body 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 usually used Fluconazole - 200-400 mg per day.
• Hormonal anti-inflammatory drugs can be used in immunodeficient conditions. For example, in such cases, you may need Sinaflan Ointment - it is applied 1-3 times a day, lightly rubbing into the affected area. Hormonal ointments are not recommended to be used for a long time, as this can cause the effect of "getting used to" the skin.
• Cytostatic drugs are antineoplastic 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 elucidated.

In addition to the drugs listed by us, the attending physician can also prescribe general restorative and immunomodulatory treatment, which includes vitamins and other agents that stimulate immunity. Such drugs do not have a direct effect on the disappearance of pyogenic granuloma. However, their use avoids complications and strengthens the body's immune response to infection.

Among such preparations it is especially possible to distinguish:

• Aevit;
• Complivit;
• Vitrum Beauty;
• extract of echinacea.

In a complex approach in the treatment of pyogenic granuloma, physiotherapeutic treatment proved to be very well established. Often, the doctor prescribes the following procedures:

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

Fizprotsedury are used only when the benign course of the granuloma is diagnosed.

Alternative treatment

Use of alternative medicine in pyogenic granuloma should be agreed with the doctor, so as not to cause irreparable harm to the health. When unpleasant symptoms appear (soreness, inflammation, edema), you can use such alternative means:

• Tincture of propolis can be bought in a pharmacy, or cooked independently (30 g of propolis insist 10 days in 200 ml of vodka). When the granuloma is moistened in the infusion with a cotton disc and applied to the affected area.
• Tincture of garlic is prepared based on 10 grams of chopped garlic for 50 ml of vodka. The tincture is kept for two weeks in a dark place, sometimes stirring the contents. With granuloma, the tincture is diluted 1: 1 and used for setting up compresses.
• When inflamed granuloma recommend to apply lotions from the juice of raw potatoes.
• For pain, rinse the granuloma with fresh onion juice.

It is worth noting that when using these methods, or other alternative methods, the granuloma itself will not disappear. It is only about alleviating the symptoms of the disease, and about slowing the growth of the tumor. It is possible to completely get rid of pyogenic granuloma only by medical methods.

[39], [40], [41], [42], [43]

Herbal Treatment

With infectious pyogenic granuloma, herbal therapy can help:

• Aloe vera is prepared as follows: the top leaves are cut as small as possible, squeezed out of the juice. Mix 50 ml of juice, 100 g of honey and 150 g of red fortified wine. The medicine is insisted for 3-4 days in the refrigerator. Take 1 tbsp. L. Before eating.
• The motherwort infusion is cooked like tea. Drink 100 ml 2-3 times a day.
• Make bandages on the basis of St. John's wort oil or Kalanchoe ointment.
• Inside take infusions and decoctions of herbs such as plantain, aloe, sea buckthorn, turn, chamomile, St. John's wort, sage, arnica, calendula.
• To prevent recurrences, granulomas are recommended to take an extract of Eleutherococcus or Saparal - 30 drops twice a day for 2-4 weeks.

Homeopathy

The intake of homeopathic remedies has practically no contraindications - except for a possible allergy to the drug. Such medicines are prescribed by the homeopathic physician individually, since according to the principle of homeopathy one needs to influence the cause, and not the manifestations of the disease.

With granulomas, causticum, Tuya, Grafitis, Barium carbonicum are shown.

With bleeding apply Acidum nitrikum, Tuya.

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

To support the immune defense of the body suitable drugs such as Crotus, Gepar Sulfur, Sulfur iodate.

Removal of pyogenic granuloma

Not all varieties of pyogenic granulomas have to be treated surgically. For example, neoplasms of infectious nature, or those that have arisen as a result of autoimmune reactions, are meaningless to delete, since they subsequently necessarily recur.

Pyogenic granulomas are not removed in such cases:

• if the granule is plentiful, and they grow rapidly;
• if there is a high risk of recurrence of the granuloma;
• if there is a danger of spreading infectious agents from the outbreak;
• If the granuloma sprouts from the deep layers;
• if there is a danger of complications from the operative removal of the neoplasm;
• If pyogenic granuloma can be eliminated by conservative treatment.

Most often, removal is prescribed with pyogenic neoplasm in the oral cavity.

Removal of the pyogenic granuloma by the laser is currently considered to be the most qualitative and sparing kind of operation in this direction. Laser beams can clearly affect the neoplasm, without damaging the healthy nearby tissue. In this way, surface vascular tumors are often removed: during the operation, the risk of bleeding is eliminated, and healing takes place very quickly and painlessly.

Laser removal is not used only if the dimensions of the pyogenic granuloma exceed 15-20 mm in diameter. In such a situation, the doctor can remove the tumor by normal surgical intervention.

Prevention

The list of preventive measures for preventing the development of pyogenic granuloma consists of general recommendations for a healthy lifestyle and on strengthening the body's defenses. In addition, it is very important to regularly be examined by medical specialists - especially the dentist, the gynecologist (for women) and the 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, so as not to become infected with sexually transmitted diseases.

[44], [45], [46]

Forecast

The prognosis of pyogenic granulomas can be called favorable. If the patient asked for medical help in a timely manner, and also complied with all the doctor's recommendations, the problem in most cases can be solved positively.

Granuloma in the oral cavity is usually removed by the operative route, often - together with a sick tooth.

Cumulative pyogenous formations can usually be eliminated by conservative treatment.

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

[47], [48]