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Pyogenic Granuloma of the Lip With Complete Resolution After Topical Propranolol

October 2019 | Volume 18 | Issue 10 | Editorials | 1061 | Copyright © October 2019


Alexandra Castro Goetze MD,ª Elisa Mayumi Kubo Sasaya MD,ª Felipe Bochnia Cerci MD,ª Stanislav N. Tolkachjov MD,B Betina Werner MD MSc PhD,c

ªDepartment of Dermatology, Hospital de Clínicas da Universidade Federal do Paraná. Curitiba, Brazil

BEpiphany Dermatology, Dallas, TX

cDepartment of Pathology, Hospital de Clínicas da Universidade Federal do Paraná. Curitiba, Brazil

or hyperpigmentation. Despite its high response rate, surgical treatment may not be the first option for children or for large lesions located in critical areas. Nonsurgical treatments for PG have been reported with variable results, including imiquimod, bleomycin, ingenol mebutate cream, phenol, topical beta-blockers (timolol 0.5% and propranolol 1%), and silver nitrate.1,5 Propranolol, a non-selective beta-adrenergic receptor blocker, is the first-line oral therapy for complicated infantile hemangiomas. For PG, topical propranolol use has been rarely reported in children, with favorable results.1,5

Our case demonstrates a unique histopathologic presentation of pyogenic granuloma on a close spectrum with a plasma cell granuloma. The diagnostic clues to these diagnoses are discussed. Topical non-selective beta-blocker (propranolol) may be a safe and effective empiric therapy to treat pyogenic granuloma in a cosmetically sensitive area.

Disclosure: The authors have no conflict of interest.
References:
  1. Wollina U, Langner D, França K, et al. Pyogenic granuloma - a common benign vascular tumor with variable clinical presentation: new findings and treatment options. Open Access Maced J Med Sci. 2017 Jul 13;5(4):423-426.
  2. Akamatsu T, Hanai U, Kobayashi M, Miyasaka M. Pyogenic granuloma: a retrospective 10-year analysis of 82 cases. Tokai J Exp Clin Med. 2015 Sep 20;40(3):110-4.
  3. Sabarinath B, Sivapathasundharam B, Vasanthakumar V. Plasma cell granuloma of lip. Indian J Dent Res. 2012 Jan-Feb;23(1):101-3.
  4. Ballesteros E, Osborne BM, Matsushima AY. Plasma cell granuloma of the oral cavity: a report of two cases and review of the literature. Mod Pathol. 1998 Jan;11(1):60-4.
  5. Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol. 2018 Oct 21. [Epub ahead of print].
  6. Just U, Hinterhuber G, Knobler R, Neumann R. A potassium-titanyl-phosphate laser is an efficacious tool in the treatment of pyogenic granulomas. A retrospective study in 28 patients. Photochem Photobiol Sci. 2018 Oct 31. [Epub ahead of print].