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Review
. 2024 Sep 13;12(9):e6160.
doi: 10.1097/GOX.0000000000006160. eCollection 2024 Sep.

Pyogenic Granuloma Diagnosis and Management: A Practical Review

Joseph D Kaleeny  1 , Jeffrey E Janis  1
Affiliations
Review

Pyogenic Granuloma Diagnosis and Management: A Practical Review

Joseph D Kaleeny et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Pyogenic granuloma (PG), or lobular capillary hemangioma, poses a clinical challenge with its uncertain etiology and treatment options. Although the clinical features and prevalence of PGs are well established, definitive evidence-based treatments remain elusive. This practical review aims to illuminate the complexities of PG management by analyzing surgical interventions based on literature analysis.

Methods: A PubMed/Medline search of "pyogenic granuloma" and "surgery" yielded 1171 studies. Inclusion criteria targeted intervention-associated PG complications over 5% and treatment modalities, excluding nonclinical studies and topics unrelated to plastic and reconstructive surgery. Screening involved Oxford level of evidence, patient data extraction, complications, intervention types, success rates, sessions, follow-ups, and treatments.

Results: Thirty-one studies met inclusion criteria. Most studies were retrospective (67.7%). Ten studies satisfied intervention-linked eruptions, primarily oculoplastic, whereas 21 investigated both surgical and nonsurgical treatment modalities. Across interventions, 3579 patients (age: 34.2-85.7 years) were involved. Postsurgical PG complications averaged 15.1% and were treated predominantly with surgical excision, achieving nearly complete resolution. Surgical and nonsurgical treatment studies included 1233 patients (age: 3-46.5 years), demonstrating a 68.2% average resolution after a single session, with surgical excision exhibiting the highest success rate (96.2%) and minimal complications.

Conclusions: This practical review highlights the complexities of managing PG, emphasizing a spectrum of effective treatments and potential postoperative complications. Ophthalmologic procedures showed PG incidences of 9%-24.4%. Surgical excision proved highly effective, surpassing methods like lasers and injectables that exhibited varied success rates requiring multiple treatment sessions. Challenges included study diversity and varying evidence levels, warranting further comparative research for PG management strategies.

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Conflict of interest statement

Dr. Janis receives royalties from Springer Publishing and Thieme Publishers. The other author has no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Clinical presentation of a PG on the frontal region of the head. Photograph attribution: Penny Jane Williamson, ID: 2246820423.
Fig. 2.
Fig. 2.
Clinical presentation of a PG on the maxillary interdental gingiva. Photograph attribution: Kasama Kanpittaya, ID: 1421389106.
Fig. 3.
Fig. 3.
Flowchart of studies included in the practical review.
Fig. 4.
Fig. 4.
Funnel plot of meta-analysis.
Fig. 5.
Fig. 5.
Galbraith plot of meta-analysis.
Fig. 6.
Fig. 6.
Forest plot of subgroup analysis among various types of treatment modalities and different lesion locations.
Fig. 7.
Fig. 7.
Clinical presentation of a PG on the second digit of the hand. Photograph attribution: CLS Digital Arts, ID: 182431496.
Fig. 8.
Fig. 8.
Clinical presentation of a PG on the inferior palpebral margin. Photograph attribution: ARZTSAMUI, ID: 364003601.
Fig. 9.
Fig. 9.
Flowchart diagram for a practical approach on PG management.
See this image and copyright information in PMC

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