Pyogenic granuloma vasular lesions

Pyogenic granulomas are vascular lesions that are commonly red colored, oozing and bleeding. They are always benign skin growths. Their histological features resemble those seen in capillary hemangioma, which occur at sites of a previous skin injury, such as, sharp trauma, insect bite and other penetrating injuries. The head, neck, upper trunk, hands and feet are the most commonly affected sites.

Pyogenic granuloma can occur at any age, but is least common in the very young and the very old. It is seen often in pregnant women and those taking the drugs Indinavir, Soriatane, Accutane and oral contraceptives. Pyogenic granuloma in pregnant women is called ‘pregnancy tumors’.

Pyogenic granulomas have an inflammatory component, with a prominent presence of excessive superficial vasculatures. It is always present with a central feeding arteriole comparable to the anatomy of a spider angioma. The diameters of the vessels are between millimeters. The distribution is usually focal and only single lesions present from previous injury.

Because the lesions in pyogenic granulomas vary, laser treatment may not be very effective. The laser treatment improves only after the hypertrophy component of the lesions is surgically removed. Laser treatments may also be more successful if the treatment is started early and if diascopy is used to stop flow in the feeding arteriole, release and for subsequent treatment of the superficial component.

Among laser therapies, PDL remains the first choice. Ordinarily in PDL treatment, while parameters, such as, pulse width, spot size, power density and cooling may be set at standard settings, successful closure of the arteriole may need multiple pulses. The non- vascular residues of pyogenic granulomas have been successfully treated by CO2 lasers, giving good cosmetic results.