Pyogenic Granuloma and Silver Nitrate

Pyogenic granuloma is a common, benign, vascular lesion of the skin that presents as a rapidly growing papule or polyp that bleeds easily after minor trauma. It is an acquired reactive hyperproliferative vascular response to various injuries (penetrating trauma, infection) and chemical stimuli (hormones, retinoid therapy). The most commonly affected sites are the hands, feet, lips, face, and upper trunk.

On inspection, the typical exophytic pyogenic granuloma pops out of the skin with inward growth of the surrounding rim of epidermis, which can cause a pedunculated appearance of the lesion. You can see this on the lateral oblique view of the thumb (left panel) in the above image.

Many treatment strategies exist, ranging from expectant management to surgical excision. A simple treatment is silver nitrate cauterization, which can be done in the office or the ED. The patient above had silver nitrate cauterization, and the silver nitrate can be seen as small radioopaque fragments near the wound.

The bone destruction seen above (right panel) is osteomyelitis, related to the infectious etiology of the pyogenic granuloma in this patient.

It should go without saying that this is not a radiologic diagnosis.

References

• Gilmore A, Kelsberg G, Safranek S. Clinical inquiries. What's the best treatment for pyogenic granuloma? J Fam Pract. 2010 Jan;59(1):40-2.
• Quitkin HM, Rosenwasser MP, Strauch RJ. The efficacy of silver nitrate cauterization for pyogenic granuloma of the hand. J Hand Surg Am. 2003 May;28(3):435-8.
• Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. Br J Dermatol. 2006 Jun;154(6):1108-11.