Abstract
Background
Pyogenic granulomas are acquired, benign growths of capillary blood vessels that are
commonly seen in the pediatric population. Patients with these lesions often present
to emergency departments and urgent care centers with persistent bleeding after minor
trauma. Much of the published literature describing the management of pyogenic granulomas,
however, is focused on outpatient or definitive therapies, and there is limited information
on the management of acute bleeding.
Objective
We conducted a narrative review to present and evaluate strategies and therapies available
to emergency physicians for managing actively bleeding pyogenic granulomas in acute
care settings.
Discussion
Multiple options are available to emergency physicians to achieve hemostasis. Direct
pressure with a nonadherent dressing remains first-line treatment. Additional therapeutic
options, such as dressings impregnated with topical vasoconstrictors or hemostatic
dressings or agents, can be used if bleeding persists. Certain approaches—silver nitrate,
suture ligation, or electrocautery—may be available to some emergency physicians.
These therapies, however, can compromise future histologic analysis of tissue for
definitive diagnosis and have potential risks.
Conclusion
Although there are multiple options to achieve hemostasis in cases of bleeding, some
treatments may lead to suboptimal cosmesis or interfere with future management. Many
bleeding pyogenic granulomas will become hemostatic with treatments available to emergency
physicians. Surgical consultation may be warranted for pyogenic granulomas that are
unresponsive to the therapies described in this review.
Keywords
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Article info
Publication history
Published online: May 02, 2022
Accepted:
April 23,
2022
Received in revised form:
March 29,
2022
Received:
February 7,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
