How to Treat Pyogenic Granuloma

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Pyogenic granuloma, also known as lobular capillary hemangioma, is a common skin condition for individuals of any age, though it is most common in children and young adults. [1] It grows rapidly and is characterized by small red lumps that may ooze and look like raw hamburger meat. [2] The most common sites for pyogenic granulomas are the head, neck, upper trunk, hands, and feet. Most growths are benign and often found at the site of a recent injury. [3] You can treat pyogenic granuloma by having it removed surgically or applying medications to the lesion, as it will rarely heal on its own. [4]

Method 1
Method 1 of 3:

Applying Topical Medications to Pyogenic Granuloma

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  1. In some cases, your doctor may suggest leaving a smaller pyogenic granuloma to heal on its own. You may also receive a prescription for a topical medication to apply to the granuloma. The two topical medications for which you may receive a prescription are: [5]
    • Timolol, a gel often used on children and for granulomas
    • Imiquimod, which stimulates the immune system to release cytokines [6]
    • Silver nitrate, which your doctor may apply
  2. Clean the area that you plan to treat to remove any bacteria at the site or on your surrounding skin. Gently wash with a mild, unscented soap and warm water. It’s common for pyogenic granuloma to bleed easily and you shouldn’t be scared by this; however, if you are treating someone else, be sure you are wearing gloves to protect yourself from exposure to their blood.
    • Consider using an antiseptic solution to clean the area if you like, though soap and water disinfects just as well.
    • Dry off your skin around the granuloma by patting it. This can prevent excessive bleeding.
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  3. If your doctor has prescribed you imiquimod or timolol, apply the treatment gently to the affected area. Repeat as many times per day as your doctor prescribes.
    • Be sure to use as little pressure as possible when dabbing the medication on your granuloma. This can minimize any bleeding that may occur.
    • Follow the instructions for application by your doctor, who will determine the proper dosage. Let your doctor know if you experience any reactions to the medication.
  4. Because skin affected by granuloma tends to bleed easily, it is important to keep it clean, dry, and protected. You can do this by keeping it covered with a non-adhesive sterile bandage until any bleeding stops, which may be one to two days or longer.
    • Hold the bandage in place with medical tape. Apply it to the bandage on an area of your skin that is not affected by the granuloma.
    • Ask your doctor how long you should keep the granuloma covered.
    • Change your dressing at least every other day or when it is soiled. It is important to do this because a dirty bandage could lead to a secondary infection.
  5. It may be tempting to pick at a granuloma or crust that may form over it. You should avoid doing this because it could spread bacteria or injure healing skin. Allow the granuloma to complete it’s course of topical treatment and consult your doctor if you notice any potential problems.
  6. Your doctor may opt to apply a silver nitrate to your granuloma. This will chemically cauterize, or burn off, your granuloma. This antiseptic solution can help with bleeding and may effectively reduce your pyogenic granuloma. [7]
    • Watch for severe reactions to silver nitrate treatments such as black scabs and skin ulcerations. See your doctor as soon as possible to prevent infection or further injury.
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Method 2
Method 2 of 3:

Seeking Surgical Treatment

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  1. Surgical removal is the most common treatment for granulomas, as there is a lower rate of recurrence with surgery. Many doctors remove granulomas with curettage and cauterization. This involves scraping off the granuloma with a tool called a curette and then cauterizing the surrounding blood vessels to minimize the chances of regrowth. It may also help stop bleeding. [8] After the procedure you should:
    • Keep the wound dry for 48 hours
    • Change your dressing daily
    • Apply pressure by securing a bandage and tape to the site, which can prevent bleeding
    • Watch for signs of infection including severe redness, swelling, severe pain, fever, and discharge from the wound
  2. Your doctor may also suggest cryotherapy, especially for smaller lesions. [9] This treatment involves freezing off granulomas with liquid nitrogen. The low temperature of the treatment can reduce cell growth and inflammation through vasoconstriction, which is the narrowing of blood vessels. [10]
    • Observe your wound after the treatment and follow any instructions from your doctor. A granuloma wound caused by cryotherapy generally heals within seven to 14 days. Pain will generally last for three days.
  3. If you have large or recurrent granuloma, your doctor may suggest excising them. This treatment has the highest cure rates. [11] This procedure involves removing the granuloma and its related blood vessels to reduce the risk of it growing back. Your doctor may also send a small sample to a lab to examine for any possible malignancy. [12]
    • Allow your doctor mark the excision site with a surgical marker. This won’t stain your skin. They will then anesthetize the site to minimize any discomfort you may have. After this, the doctor will remove the granuloma with a scalpel and/or sharp scissors. You may smell some burning if the doctor uses cautery to stop bleeding, but this won’t harm you. If necessary, you may get stitches at the excision incision site.
  4. Some doctors may suggest laser surgery to remove the lesion and burn its base or shrink smaller granulomas. [13] Consider this procedure before getting it, as it is not necessarily better at removing or preventing pyogenic granulomas as surgical excision. [14]
    • Talk to your doctor about the benefits of laser surgery over surgical excision for your granuloma. Ask any questions you may have about the procedure including about healing, care, and recurrence.
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Method 3
Method 3 of 3:

Caring for the Surgical Site

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  1. The surgeon or doctor may have you cover the area where your granuloma was removed. This helps protect the wound from infection and can absorb any blood or fluid leakage. [15]
    • Put on a new covering with light pressure if you experience any bleeding. If you have a lot of bleeding, contact your doctor.
    • Wear the bandage for at least one day after your medical professional removes the granuloma. Keep the wound as dry as you can, which helps it heal and keeps bacteria out of the site. Avoid showering for at least a day after the procedure, unless your doctor advises that it is safe.
  2. Change the bandage a day after the procedure, or sooner if necessary. The bandage keeps the site clean and dry. It can also minimize the risk of infection or serious scarring. [16]
    • Use bandages that let your skin breathe. Air flow can promote healing. You can get breathable bandages at most drug stores and at many grocery stores. Your doctor may also provide you with dressings for the wound.
    • Change the bandage until you see no open wounds or as instructed by your doctor. You may only need to keep the area bandaged for one day.
  3. Washing your hands is important any time you touch the site or change the bandages. This reduces the risk of infection or scarring. [17]
    • Wash with warm water and a soap of your choice. Lather your hands for at least twenty seconds. [18]
  4. It’s important for healing and preventing infection to keep the surgical site clean. Wash the area daily with a mild cleanser or soap, which can get rid of any bacteria on your skin. [19]
    • Use the same soap and water to clean the site that you would on your hands. Stay away from scented cleansers to avoid irritation. Rinse the site thoroughly with warm water.
    • Dab on a bit of hydrogen peroxide if your doctor instructs you or if you see any redness that may be an infection. [20]
    • Pat the wound dry before putting on the covering.
  5. Any type of surgical removal may cause mild pain or tenderness at the removal site. Take an over-the-counter pain reliever to relieve discomfort and decrease any swelling. Ibuprofen, naproxen sodium or acetaminophen can reduce any discomfort. Ibuprofen may also minimize swelling. Get a prescription for pain medication if you have severe pain.
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Expert Q&A

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  • Question
    What do I do if my pyogenic granuloma comes back after surgery?
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine.
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Expert Answer
    Unfortunately, this is not uncommon. If the pyogenic granuloma comes back, you may require another surgery. Talk to your doctor if you have any concerns about the pyogenic granuloma returning.
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  • Question
    How do I deal with pyogenic granuloma on my lips?
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine.
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Expert Answer
    For sensitive areas such as the lips, medical management will be tried before surgery.
    Thanks! We're glad this was helpful.
    Thank you for your feedback.
    If wikiHow has helped you, please consider a small contribution to support us in helping more readers like you. We’re committed to providing the world with free how-to resources, and even $1 helps us in our mission. Support wikiHow
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      References

      1. ↑ https://medlineplus.gov/ency/article/001464.htm
      2. ↑ https://www.aocd.org/page/PyogenicGranuloma
      3. ↑ https://medlineplus.gov/ency/article/001464.htm
      4. ↑ https://www.dermnetnz.org/topics/pyogenic-granuloma/
      5. ↑ https://emedicine.medscape.com/article/1084701-treatment
      6. ↑ https://www.dermnetnz.org/topics/imiquimod/
      7. ↑ https://www.news-medical.net/health/Treating-Pyogenic-Granuloma.aspx
      8. ↑ https://www.dermnetnz.org/topics/pyogenic-granuloma/
      9. ↑ https://www.dermnetnz.org/topics/pyogenic-granuloma/
      1. ↑ https://www.aafp.org/afp/2004/0515/p2365.html#sec-1
      2. ↑ https://www.aocd.org/page/PyogenicGranuloma
      3. ↑ https://www.mountsinai.org/health-library/diseases-conditions/pyogenic-granuloma
      4. ↑ https://www.dermnetnz.org/topics/pyogenic-granuloma/
      5. ↑ https://www.aocd.org/page/PyogenicGranuloma
      6. ↑ https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cutaneous_nerve_lab/physicians/patient_instructions_biopsy_site_care.html
      7. ↑ https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cutaneous_nerve_lab/physicians/patient_instructions_biopsy_site_care.html
      8. ↑ https://medlineplus.gov/ency/patientinstructions/000040.htm
      9. ↑ https://www.cdc.gov/clean-hands/about/?CDC_AAref_Val=https://www.cdc.gov/handwashing/when-how-handwashing.html
      10. ↑ https://medlineplus.gov/ency/patientinstructions/000040.htm
      11. ↑ https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cutaneous_nerve_lab/physicians/patient_instructions_biopsy_site_care.html
      12. ↑ https://www.ncbi.nlm.nih.gov/pubmed?term=10827405

      About This Article

      Article Summary X

      To treat pyogenic granuloma, talk to your doctor so they can prescribe a topical medication that will help clear your skin. Alternatively, your doctor might recommend surgery to remove the granuloma. You can also ask about cryotherapy, where the granuloma is frozen off, or laser surgery, where a medical professional uses lasers to shrink the granuloma. If the granuloma is small, your doctor might recommend letting it heal on its own. Either way, avoid picking at granulomas since it could cause the bacteria to spread. For tips from our Medical co-author, like how to care for your skin after having surgery to remove pyogenic granuloma, read on.

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