Visual Diagnosis

Case: A 4-year-old girl presents with an actively bleeding lesion over the proximal area of her palm.

Diagnosis:

This patient has a pyogenic granuloma (lobular capillary hemangioma).

A pyogenic granuloma is a noninfectious vascular lesion that is most commonly found on the fingers, hands, and face, and occasionally on oral mucosal surfaces. The initial appearance may be of a small red papule that increases in size over weeks. It may have a smooth or ulcerated surface and can be pedunculated or sessile, singular or multiple in number. A collarette of scaly skin may be present at the base. Though the site of these lesions is usually over normal skin or mucosa, they may also be found in capillary or arteriovenous malformations. The lesion is common in children, with a mean age of 5.9 years reported in one study.1 The cause is unknown.

Clinical Practice Pearls:

• Direct pressure to the site is usually adequate to stop acute bleeding, which is the main reason why patients seek care. Ulceration and acute bleeding are common.


• Full thickness surgical excision of the lesion is the traditional treatment. Alternative management includes shave or curettage surgical excision followed by electrodesiccation of the base, laser therapy, cryotherapy, injection sclerotherapy, and topical application of medications to smaller lesions.2

Futher Reading:

• Pagliai KA, Cohen BA. Pyogenic granulomas in children. Pediatr Dermatol. 2004;21(11) :10.


• Lee J, Sinno H, Tahiri Y, et al. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg. 2011;64(9):1216-1220.