Home > BNSSG ICB > Development Area >

Pyogenic Granuloma - Draft

Checked: 10-09-2024 by Next Review: not set yet

Overview

Please see the Pyogenic Granuloma page (PCDS website) for advice.

Pyogenic granulomas are most common in children and young adults but can occur at any age.

Trauma is often an important initiating factor, although a clear history cannot always be ascertained.

Although the diagnosis is often straightforward the main differential diagnosis is that of a hypomelanotic melanoma, which tend to bleed less than pyogenic granuloma. Other features that may increase the level of suspicion include no clear history of trauma and an atypical site or age group (1).

Red Flags

If diagnosis is in doubt and malignancy is a concern then please refer using one of the USC/2WW pathways below:

Children & Young People – USC (2WW)- for children under 16 years old.
Skin - USC (2WW) - for patients aged 16 years or older.

What to do before referral

If malignancy is not a concern then treatment with salt and vaseline in primary care can be an effective treatment - see the Pyogenic granuloma (pcds.org.uk) patient leaflet.

If no improvement within 2 weeks then diagnosis should be reviewed. If red flags then refer USC/2WW (see section above).

Timolol solution/gel has been suggested as a treatment but this is not advised by the BNSSG formulary due to lack of evidence of effectiveness - see Decisions 4th March 2014 (Remedy BNSSG ICB)

If diagnosis still in doubt, consider requesting dermatology advice and guidance (available for children and adults) with good quality photos.

Umbilical Granuloma

See the Umbilical Granuloma page for advice and a link to a parent leaflet on treatment.

Persistently discharging umbilical granulomas in neonates could signify deeper involvement (1) - consider Advice & Guidance - Dermatology. (paediatric) or referral if criteria for prior approval are met (see below).

Referral

Referrals to secondary care for all patients (other than those with suspected malignancy) are restricted by the Benign Skin Lesion policy.

If criteria are met, then complete the Prior Approval form and submit a referral via to dermatology via eRS.

Resources

(1) Pyogenic granuloma (pcds.org.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.