3.2.7 Pyogenic granuloma

Grading & Level of Importance: C




Granuloma pediculatum, Granuloma teleangiectaticum, lobular capillary hemangioma,  pseudobotryomycoma, eruptive angioma, proliferating angioma; epulis granulomatosa (gingiva).


Frequent; all ages; M = F; more common in white than in black people .


Misnomer, since this exophytic benign reactive proliferation of small vessels has nothing to do with bacterial “pyogenic” (pus producing) infection, like “botryomycosis”, which again is a misnomer (mostly due to staphylococcal, not fungal infection).

Aetiology & Pathogenesis

Injuries, wounds, hormones (pregnancy) are initiating factors. Nitrogen Monoxyd Synthase (NOS), Fibroblast Growthh Factor (FGF) and Connective Tissue Growth Factor (CTGF) are important pathogenetic factors.

Signs & Symptoms

Friable, bleeding exophytic proliferatiion with collarette by the surrounding epidermis. Occasionally small angiomatous satellites in the vicinity.


Wounds; areas exposed to injuries; extremities, face, tips of the fingers and toes; lips, tongue, gingiva (epulis).


  • eruptive pyogenic granuloma
  • subcutaneous intravascular pyogenic granuloma
  • pyogenic granuloma with satellites
  • pyogenic granuloma on lips, gingiva (epulis)

Laboratory & other workups

Not needed; micobiologic swab (see differential diagnoses).


Erosion on the surface with hemorrhagic crust formation; proliferation of newly formed capillaries with many mitoses around a central vessel. Mixed cellular inflammatory infiltrate in the dermis. Collarette of the epidermis.


Spontaneous involution possible; prognosis good following complete removal.


Bleeding; superinfection; recurrence if not completely removed.


Typical clinical feature and history (trauma, pregnancy).

Differential diagnosis

Granulation tissue, amelanotic melanoma, hemangiosarcoma, botryomykosis (bacterial infection), bacillary angiomatosis (Bartonela Henselae-infection i.e. in HIV).

Prevention & Therapy

Avoid injuries. Removal by excision or laser.


Cave: Confusion with malignant melanoma.

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