Pyogenic granuloma L98.0

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 18.06.2024

Dieser Artikel auf Deutsch


angioma eruptives; angioma proliferating; Botryomycosis; Botryomykom; eruptive angioma; Eruptive hemangioma; Granuloma pediculatum; Intravenous pyogenic granuloma; Lobular capillary hemangioma; Nail fold angiomatosis; Peduncle tubers; Pregnancy tumor; proliferating angioma; Pseudobotryomykom; pyogenic granuloma; teleangiectatic granuloma

This section has been translated automatically.

Dor and Poncet, 1897

This section has been translated automatically.

Common, mostly after minor injuries, but also spontaneously developing, rapidly exophytic, benign vascular tumor of the skin and mucous membranes close to the skin.

This section has been translated automatically.

Clinical and histological classification:

  • Classic granuloma pyogenicum
  • Epulis gravidarum of the gingiva
  • Subcutaneous and intravascular granuloma pyogenicum (histological diagnosis)
  • Disseminated (eruptive) granuloma pyogenicum (multiple small mostly aggregated nodules)
  • Granuloma pyogenicum with satellitosis (especially in children and young adults; recurrent tumor with synchronous flare-up of multiple satellite nodules)

This section has been translated automatically.

Frequently occurring after banal injury, with subsequent development of excessive, vascularized granulation tissue; more common during pregnancy. Apparently BRAF and RAS mutations play a role in the pathogenesis of this "reactive" and therefore benign tumor. Granulomata pyogenica are also frequently observed with isotretinoin.

This section has been translated automatically.

Common during pregnancy (epulis gravidarum of the gingiva) with postpartum involution.

Age of first manifestation: rare in the 1st year of life; most common in the 2nd-5th decade of life.

This section has been translated automatically.

Mainly lips, scalp, face, fingertips, tongue, palm and toes, less frequently localizations in the area of the oral mucosa. An esophageal localization has been described (Suarez-Zamora DA et al. 2018).

Clinical features
This section has been translated automatically.

1.0-3.0 cm in size, rarely larger, solitary, soft, spherical, slightly bleeding, red, blue, or black, sharply demarcated papule (nodule).

Usually absent to little pain.

As it grows, there is usually constriction of the base, which is bordered by the epidermis in a collar-like fashion. The surface is often eroded, weeping, later ulcerated, and possibly covered with a bled-in black crust.

Differentiate "uncomplicated" granuloma pyogenicum from (rare) bacterial nailfold angiomatosis, which is more likely to be associated with reactive granulation tissue in unguis incarnatus.

Also belonging to the lobular capillary hangiomas of the granuloma pyogenicum type are the rare eruptive disseminated cases (satellitosis), which may occur after incomplete removal of the "primary tumor". In these cases, osseous destruction has also been described. In this respect, the dignity of this rare form of manifestation remains questionable.

This section has been translated automatically.

Exophytic, multilobular, mature cell (CD31+) capillary tumor in papillary and reticular dermis. Absent or only thin epithelial covering. Numerous small or larger vascular spaces with clusters of erythrocytes. In the upper parts of the tumor, there is often a vigorous accompanying inflammatory reaction with neutrophilic granulocytes and lymphocytes in the presence of edematous connective tissue stroma. In sections, especially in the deeper parts, also solid tumor nodules with only a few vascular spaces. Numerous mitoses (Ki-67 positivity is significantly increased), moderate endothelatypia. In late stages widened septa with regressed vascular parenchyma.

This section has been translated automatically.

The clinical picture is diagnostic.

Differential diagnosis
This section has been translated automatically.

Malignant melanoma; angiosarcoma. In multifocal, eruptive occurrence the epithelioid hemangiodendothelioma must be excluded.

This section has been translated automatically.

A recurrence after incomplete removal may occur. Satelliteosis is rare.

This section has been translated automatically.

Excision without safety distance under local anesthesia, histological examination to exclude malignancy. Possibly also treatment attempt with Neodymium-YAG-Laser and CO 2 -Laser. As there is a risk of recurrence in ablative procedures, this treatment option is not recommended!

This section has been translated automatically.

Great tendency to ulceration with bleeding tendency. If left untreated, granuloma pyogenicum may shrink after several months. A soft fibromatous papule remains as a relic. The recurrence rate after incomplete removal is high.

This section has been translated automatically.

  1. Baran R (2002) Pyogenic granuloma-like lesions associated with topical retinoid therapy. J Am Acad Dermatol 47: 970
  2. Exner V et al (2001) Sebaceous gland carcinoma of the neck. Dermatologist 52: 147-149
  3. Groesser L et al (2016) BRAF and RAS mutations in sporadic and secondary pyogenic granuloma. J Invest Dermatol 136:481-486.
  4. Holbe HC et al (2003) Surgical pearl: ligation of the base of pyogenic granuloma--an atraumatic, simple, and cost-effective procedure. J Am Acad Dermatol 49: 509-510.
  5. Kocer U et al (2003) Intravenous pyogenic granuloma of the hand. Dermatol Surg 29: 974-976
  6. Mazereeuw-Hautier J (2003) Pyogenic granuloma within unilateral dermatomal superficial telangiectasia. Br J Dermatol 148: 823-824.
  7. Mensch A et al (2007) Multifocal eruptive epithelioid cellular hemangioma of lobular capillary type (granuloma telangiectaticum type). derm 13: 124-128.
  8. Musumeci ML et al (2013) Two pediatric casesof pyogenic granuloma treated with imiquimod 5% cream: combined clinical and
  9. dermatoscopic evaluation and review of the literature. G Ital Dermatol Venereol 148:147-152.
  10. Poncet et Dor A (1897) De la botryomycose humaine. Rev der Chir (Paris) 18: 996-997.
  11. Purwar P et al (2015)'Granuloma gravidarum': persistence in puerperal period an unusual presentation. BMJ Case Rep 9 doi: 10.1136/bcr-2014-206878.
  12. Raulin C et al (1997) Granuloma pyogenicum--removal with the CO2 laser. Dermatologist 48: 402-405
  13. Raulin C et al (2002) The combined continuous-wave/pulsed carbon dioxide laser for treatment of pyogenic granuloma. Arch Dermatol 138: 33-37
  14. Suarez-Zamora DA et al (2018) Esophageal pyogenic granuloma: A Case Report and Review of the Literature. Int J Surg Pathol 26:735-738
  15. Taira JW et al (1992) Lobular capillary hemangioma (pyogenic granuloma) with satellitosis. J Am Acad Dermatol 27: 297-300.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 18.06.2024