Pyogenic Granuloma Successfully Treated With Electric ... · 229 Journal of Basic and Clinical...
6
229 Journal of Basic and Clinical Pharmacy www.jbclinpharm.com Pyogenic Granuloma Successfully Treated With Electric Cautarization — Case Study Muaed Jamal Alomar Clinical Pharmacy Department, Faculty of Pharmacy and Health Sciences, Ajman University of Science and Technology Network, Fujairah, UAE. TREATMENT e treatment was done in three stages; Topical application of salicylic acid (twice daily) in order to burn the af- 1. fected area. e treatment was continued for one month. Figure 4 shows the results of that particular treatment. e results were not successful and bleeding continued. Burning the area with silver nitrate rods; once every other day for two 2. weeks. Figure 5 shows the results of that particular treatment. e results were partially successful. e bleeding continued but the quantity de- creased. e problem with this treatment was the burning sensation and the severe excruciating pain accompanied with the application of silver ni- trate. e pain continued for hours after the application. Cauterization; the area was locally anaesthetized and cauterized electri- 3. cally. A course of antibiotics (amoxycilline with clavulinic acid) was given after the procedure in order to prevent any complications. e procedure took 15 minutes. After one week of the procedure, bleeding stopped, but a fluid discharge continued (figure6). ree weeks later the discharge stopped completely and the injury started to heal (figure 7). Another 2 weeks later the healing was complete and bleeding had stopped (figure 8). DISCUSSION Pyogenic granuloma is a benign vascular erosion of the skin and mucosal areas with unidentified etiology [1]. It is also referred to as lobular capillary hemangioma. It consists of a group of blood vessels arranged in a lobular form. It might occur at any age but it is more common in children and young people with an increased prevalence among females. It was originally considered the tumor of pregnancy [2]. Pyogenic granuloma presentation includes sudden growth of a vascular tissue over several weeks or months [2]. Increasing levels of pregnancy hormones might be the reason for its prevalence [3]. It has been suggested that estrogen hormone plays a major role in the development of granuloma gravidarum [11]. In the past it was thought to be a result of a bacterial infection where antibiot- ics had failed to heal the lesion. In another case study it was shown that antibiotics also failed to induce any improvement [6]. Treatment of pyogenic granuloma includes cryosurgery, curettage, electrodes- iccation, chemical cauterization, and laser surgery [4]. Silver nitrate cauterization in the office setting can treat simple cases of pyogenic granuloma [5,7]. In this case the response to silver nitrate alone was not enough to eradicate the lesion. Even though it helped in reducing the lesion and increasing the healing process when electrical cauterization procedure implemented. In a case study of an 82 year old man with pyogenic granuloma, cauterization with imiquimod 5% cream showed successful healing with no recurrence after 8 months of follow up [8]. Another study also supports the use of imiquimod 5% cream especially in children with promising results and no recurrence [9]. Laser therapy can also be used to cauter- ize the lesion with good therapeutic outcomes [10]. Laser therapy requires a skilled medical professional with good practical experience. It also requires multiple ses- sions to achieve complete healing. For this patient, electric cauterization has shown a successful and complete healing. It also left a minor scar which may disappear with time. It was a one ses- sion treatment, painless due to the use of local anesthetic. It is also fast, more eco- nomic and less invasive. *Corresponding Author E-mail: [email protected] PATIENT DATA M.O is a 37 years old man complaining of a sudden small growth with continuous bleeding on his finger, erythema- tous, painless papule lesion (figure1). e lesion was very small in size, firm and shiny when first noticed by the pa- tient. No history of trauma or accident in that area. It was tender to touch with a tendency to bleed more if touched. e patient tried topical antibiotics for one month before he went to seek medical assistance (figure2). When the bleeding couldn’t be controlled by antibiotics, he went to a GP for a general checkup. e GP diagnosed the bleeding as a superficial infection and pescribed oral cefixime 400 mg once daily for 7 days plus topical fucidic acid ointment twice daily for one month (figure3). Figure 3 shows there was no improvement after the antibiotic course. A derma- tologist was seen after that and diagnosed it as a pyogenic granuloma. A second opinion from another dermatologist was taken to confirm the diagnoses. e dermatologists decided that there was no need for biopsy at the moment because of the small area of bleeding. received on 28-10-2011 accepted on 30-01-2012 available online 15-02-2012 www.jbclinpharm.com KEY WORDS Granuloma, cauterization, silver nitrate, papule.
Transcript of Pyogenic Granuloma Successfully Treated With Electric ... · 229 Journal of Basic and Clinical...
229
Journal of Basic and Clinical Pharmacy
www.jbclinpharm.com
Pyogenic Granuloma Successfully Treated With Electric Cautarization — Case Study
Muaed Jamal Alomar
Clinical Pharmacy Department, Faculty of Pharmacy and Health Sciences, Ajman University of Science and Technology Network, Fujairah, UAE.
TREATMENTTh e treatment was done in three stages;
Topical application of salicylic acid (twice daily) in order to burn the af-1. fected area. Th e treatment was continued for one month. Figure 4 showsthe results of that particular treatment. Th e results were not successful and bleeding continued.Burning the area with silver nitrate rods; once every other day for two2. weeks. Figure 5 shows the results of that particular treatment. Th e resultswere partially successful. Th e bleeding continued but the quantity de-creased. Th e problem with this treatment was the burning sensation andthe severe excruciating pain accompanied with the application of silver ni-trate. Th e pain continued for hours after the application.Cauterization; the area was locally anaesthetized and cauterized electri-3. cally. A course of antibiotics (amoxycilline with clavulinic acid) was givenafter the procedure in order to prevent any complications. Th e proceduretook 15 minutes. After one week of the procedure, bleeding stopped, buta fl uid discharge continued (fi gure6). Th ree weeks later the dischargestopped completely and the injury started to heal (fi gure 7). Another 2weeks later the healing was complete and bleeding had stopped (fi gure 8).
DISCUSSIONPyogenic granuloma is a benign vascular erosion of the skin and mucosal areas with unidentifi ed etiology [1]. It is also referred to as lobular capillary hemangioma. It consists of a group of blood vessels arranged in a lobular form. It might occur at any age but it is more common in children and young people with an increased
prevalence among females. It was originally considered the tumor of pregnancy [2]. Pyogenic granuloma presentation includes sudden growth of a vascular tissue over several weeks or months [2]. Increasing levels of pregnancy hormones might be the reason for its prevalence [3]. It has been suggested that estrogen hormone plays a major role in the development of granuloma gravidarum [11].
In the past it was thought to be a result of a bacterial infection where antibiot-ics had failed to heal the lesion. In another case study it was shown that antibiotics also failed to induce any improvement [6].
Treatment of pyogenic granuloma includes cryosurgery, curettage, electrodes-iccation, chemical cauterization, and laser surgery [4]. Silver nitrate cauterization in the offi ce setting can treat simple cases of pyogenic granuloma [5,7]. In this case the response to silver nitrate alone was not enough to eradicate the lesion. Even though it helped in reducing the lesion and increasing the healing process when electrical cauterization procedure implemented. In a case study of an 82 year old man with pyogenic granuloma, cauterization with imiquimod 5% cream showed successful healing with no recurrence after 8 months of follow up [8]. Another study also supports the use of imiquimod 5% cream especially in children with promising results and no recurrence [9]. Laser therapy can also be used to cauter-ize the lesion with good therapeutic outcomes [10]. Laser therapy requires a skilled medical professional with good practical experience. It also requires multiple ses-sions to achieve complete healing.
For this patient, electric cauterization has shown a successful and complete healing. It also left a minor scar which may disappear with time. It was a one ses-sion treatment, painless due to the use of local anesthetic. It is also fast, more eco-nomic and less invasive.
*Corresponding Author E-mail: [email protected]
PATIENT DATAM.O is a 37 years old man complaining of a sudden small growth with continuous bleeding on his fi nger, erythema-tous, painless papule lesion (fi gure1). Th e lesion was very small in size, fi rm and shiny when fi rst noticed by the pa-tient. No history of trauma or accident in that area. It was tender to touch with a tendency to bleed more if touched. Th e patient tried topical antibiotics for one month before he went to seek medical assistance (fi gure2). When thebleeding couldn’t be controlled by antibiotics, he went to a GP for a general checkup. Th e GP diagnosed the bleeding as a superfi cial infection and pescribed oral cefi xime 400 mg once daily for 7 days plus topical fucidic acid ointmenttwice daily for one month (fi gure3). Figure 3 shows there was no improvement after the antibiotic course. A derma-tologist was seen after that and diagnosed it as a pyogenic granuloma. A second opinion from another dermatologist was taken to confi rm the diagnoses. Th e dermatologists decided that there was no need for biopsy at the momentbecause of the small area of bleeding.
received on 28-10-2011accepted on 30-01-2012available online 15-02-2012www.jbclinpharm.com
KEY WORDSGranuloma, cauterization, silver nitrate, papule.
Journal of Basic and Clinical PharmacyMuaed Jamal Alomar
www.jbclinpharm.comVol-003 Issue-001 February 2012 230
Figure 1
Figure 2
Pyogenic granuloma successfully treated with electric cautarization. Journal of Basic and Clinical Pharmacy
Vol-003 Issue-001 February 2012www.jbclinpharm.com 231
Figure 3
Figure 4
Journal of Basic and Clinical PharmacyMuaed Jamal Alomar
www.jbclinpharm.comVol-003 Issue-001 February 2012 232
Figure 5
Figure 6
Pyogenic granuloma successfully treated with electric cautarization. Journal of Basic and Clinical Pharmacy
Vol-003 Issue-001 February 2012www.jbclinpharm.com 233
Figure 7
Figure 8
Journal of Basic and Clinical PharmacyMuaed Jamal Alomar
www.jbclinpharm.comVol-003 Issue-001 February 2012 234
REFERENCES 1. Rapini, RP, Bolognia JL, Jorizzo JL. Dermatology. 2-Volume Set. 2007; St.
Louis: Mosby.2. Daley TD, Nartey NO, Wysocki GP. Pregnancy tumor: an analysis. Oral Surg
Oral Med Oral Pathol. 1991: 72:196-199.3. Ramirez. K, Bruce G. carpenter. Pyogenic granuloma: case report in a 9-year-
old girl. General Dentistry. 2002: 50:280–1.4. Matsumoto K, Nakanishi H, Seike T. Treatment of pyogenic granuloma with a
sclerosing agent. Dermatol Surg. 2001: 27(6): 521-3.5. Quitkin HM, Rosenwasser MP, Strauch RJ. The effi cacy of silver nitrate cauteriza-
tion for pyogenic granuloma of the hand. J Hand Surg Am. 2003: 28(3): 435-8.6. Leight, A. A non-healing ulcerated fi ngertip following injury. J Fam Pract.
2006: 55(3): 225-9.
7. Dollery, W. Towards evidence based emergency medicine: best BETs from theManchester Royal Infi rmary. Curettage or silver nitrate for pyogenic granulo-mas on the hand. J Accid Emerg Med. 1999: 16(2): 140-1.
8. Georgiou S, Monastirli A, Pasmatzi E, Tsambaos D. Pyogenic granuloma: Complete remission under occlusive imiquimod 5% cream. Clinical and Experimental Dermatology. 2008;33 (4): 454-456.
9. Kim SH, Yoon MS, Kim DH. The therapeutic effect of 5% imiquimod creamon pyogenic granuloma. Korean Journal of Dermatology. 2006;44 (9): 1078-1083.
10. Galeckas KJ, Uebelhoer NS. Successful treatment of pyogenic granuloma using a 1,064-nm laser followed by glycerin sclerotherapy. Dermatologic Surgery. 2009;35 (3): 530-534.
11. Demir Y, Demir S, Aktepe F. Cutaneous lobular capillary hemangioma. induced by pregnancy. J Cutan Pathol. 2004;31: 77-80.
![Annals of Clinical Case Reports Case Report - anncaserep.com · pyogenic granuloma was described [5]. The Term Pyogenic granuloma is a misnomer because the The Term Pyogenic granuloma](https://static.fdocuments.in/doc/165x107/5d0a41bb88c993cf0c8b7f5f/annals-of-clinical-case-reports-case-report-pyogenic-granuloma-was-described.jpg)
