The correct diagnosis is pyogenic granulomas—rapidly developing, usually single, benign vascular growths that can arise in days.
Pyogenic granulomas bleed easily with the slightest trauma. They are red, small (typically about 1 cm), raspberry-like, friable papules. Their base can have a well-circumscribed rim of scale, known as a collarette.
Pyogenic granulomas occur most often on exposed surfaces, such as hands, forearms, and the face, although the condition can appear in the mouth. Fingers are a frequent location. Pyogenic granulomas may be a complication of isotretinoin therapy and can arise in port-wine stains undergoing laser treatment. Sometimes there is a history of preceding trauma.
The differential diagnosis for pyogenic granuloma includes hemangioma and, in the immunocompromised (e.g., HIV-infected individuals), consider bacillary angiomatosis, which also causes bright red papules. Consider bartonellosis in patients from South America.
The treatment of choice is a shave excision followed by curettage and electrodesiccation. Consider using a topical anesthetic such as EMLA cream in preparation for the procedure. After anesthetizing with one percent lidocaine with epinephrine, perform a tangential excision. Use a curette to scrape the base, and then electrodesiccate the area. Pulsed dye laser may reduce the incidence of scarring.
Image and text courtesy of Logical Images, Inc.
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