Pyogenic Granulomas

What are pyogenic granulomas (lobular capillary hemangiomas)?

Pyogenic Granuloma Image Pyogenic granulomas, otherwise known as lobular capillary hemangiomas, are made of small clusters of growing blood vessels covered by a thin, fragile layer of skin. Often the skin breaks down, leading to bleeding and crusting. These small benign nodules can occur anywhere on the skin, including the lips and inside the mouth, and they can occur at any age. Occasionally, the nodule may disappear on its own, but usually patients seek treatment because of the inconvenient and sometimes profuse bleeding that can occur.

In the past, these nodules were thought to be infected bumps of inflamed tissue. Although these are really a type of hemangioma, and they are actually neither infected (pyogenic) nor chronically inflamed tissue (granulomas), that name has persisted because of long-term use.

What causes lobular capillary hemangiomas?

Lobular capillary hemangiomas are thought to be caused by minor skin trauma that stimulates excessive blood vessel growth, but there is also a hormonal relationship because they often occur in pregnant women.

What are the treatment options?

The treatment for lobular capillary hemangiomas can include observation to see if they will go away on their own; chemical cautery; laser for small, relatively flat nodules; shave excision followed by either laser or electric cautery; and for large or persistent lesions, surgical excision.

In rare cases, large, recurrent lobular capillary hemangiomas may benefit from combination therapy that includes beta blocker therapy directed by CHOP’s Dermatology Section.

Lobular capillary hemangiomas are always benign, and complete removal or destruction is curative. However, they can recur if treatment does not completely eliminate the growing vessels.

The CHOP difference

Children seen by the CVAP team at CHOP benefit from a multidisciplinary team with extensive experience and deep expertise in the assessment and management of lobular capillary hemangiomas. World-class specialists offer comprehensive care tailored to each child’s condition. The CVAP team at CHOP supports patients and their families every step of the way in their journey in managing a diagnosis of lobular capillary hemangiomas.

Reviewed by David W. Low, MD, Michael D. Fox, MD, MEd