A case series reported on 135 patients (mean age 26 years; range 4 months to 70 years) whose pyogenic granulomas were treated with cryotherapy.5 Seventy-eight (58%) had complete resolution with 1 session, 30% needed 2 sessions, 8% needed 3 sessions, and 5% needed 4 sessions (mean 1.58 sessions). Ninety-four percent had an excellent cosmetic result (including 12% with a small flat scar); 5% had residual hypopigmentation.
CO2 laser usually removes lesions in 1 session
Another case series of 100 patients (mean age 27 years; range 6 months to 84 years) treated with CO2 laser reported that the pyogenic granuloma was removed completely in 1 session in 98 patients. Twelve percent of patients had visible scarring and another 10% had slight textural skin changes. All patients reported satisfaction with the results.6
Pulsed dye laser works for small lesions
A case series of 22 patients (mean age 3.4 years; range 6 months to 16 years) treated with pulsed dye laser for mostly small lesions (average diameter 4 mm) on the face reported successful removal in 20 children in 1 to 6 treatment sessions (average 2.25) with no residual scarring. Two children with larger lesions required shave excision with cautery (scarring was not assessed).7
Sclerotherapy: No recurrence, inconspicuous scars
A case series reported results in 9 patients (median age 18 years; range 1-57 years) with pyogenic granuloma treated with a single injection of the sclerosing agent monoethanolamine oleate.2 All lesions disappeared without recurrence; the authors described remaining scars as inconspicuous. One patient reported residual pain lasting 4 weeks after injection of the sclerosing agent into a 1.5 cm × 1.0 cm pyogenic granuloma that hadn’t responded to previous cryotherapy.
Recommendations
A standard dermatology textbook recommends curettage with cautery, and reports that spontaneous regression is common after 6 months.8 A standard pediatric textbook recommends surgical excision with or without cautery, adding that small pyogenic granuloma lesions (<5 mm) may be removed with pulsed dye laser.9
An online textbook recommends either excision or shave (with or without curettage), but advises surgical excision with histologic confirmation for pyogenic granuloma lesions that can’t be differentiated with certainty from amelanotic melanoma, which typically grows more slowly.10