History: A 9 yo girl has a one month history of a papule on left lower lid. It has bled on one occasion. She saw her pediatrician who referred her to dermatology.
O/E: 5 mm red papule
Clinical Photo(s)
After procedure:
Lab: N/A
Histopathology: Pending
Diagnosis or DDx: Pyogenic granuloma
Treatment: The area was anesthetized with lidocaine + epi and the lesion was snipped off with a curved iris scissors. The base was gently cauterized. Patient's father held her hand during the procedure.
Questions:
Reason(s) Presented: This is the kind of case that FPs can handle in the office. It akes a few minutes to reassure the patient, and it's important to have a parent there. Often it can take weeks to see a dermatologist or ENT or ophthalmologist. The procedure is simple. These lesions can reoccur after electrodessication, and if so may require excision. Imiquimod to the base may prevent that.
References: Pyogenic granuloma in children: treatment with topical imiquimod.
Fallah H, Fischer G, Zagarella S.
Australas J Dermatol. 2007 Nov;48(4):217-20.
We report the successful treatment of five children with facial pyogenic granuloma using topical imiquimod 5% cream. In all cases, resolution of the lesions was achieved within 2-4 weeks. Local erythema and scaling, consistent with a typical imiquimod response, was the most commonly observed side effect. No systemic complications were observed in any of the patients. There has been no recurrence of any of the lesions to date. Small mildly erythematous or hypopigmented macules remain at this stage of follow up.
[Had I read this first, this might have been a better approach!! But the combination may be easier as it was very quick]
1 comment:
A very effective yet quite simple procedure. Very often we refer such cases to pediatric surgeons for removal. The surgeons usually do it under general anesthesia. With this method, the procedure can be done in one's office. One word of caution. The child must be cooperative and allow the procedure to be completed. The tumor is vascular and bleed easily if not cauterised properly. I agree the specimen should be sent for histological examination.
I have no experience using topical imiquimod in pyogenic granuloma. It sounds promising.
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