Agminated, Eruptive Pyogenic Granuloma‐Like Lesions Developing over Congenital Vascular Stains

Baselga, Eulàlia; Wassef, Michel; López, Susana; Hoffman, William Y.; Cordisco, Maria; Frieden, Ilona J.

doi:10.1111/j.1525-1470.2011.01565.x

Cited by 27 publications

(16 citation statements)

References 32 publications

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“…The development of multiple satellite lesions at and around the site of a previously destroyed PG (disseminated eruptive PG), as in the present case, is considered an extremely rare event . This variant is not well‐documented in the literature, but it is known that it usually occurs on the shoulders or upper trunk of children and, sometimes, in association with visceral disease .…”

Section: Discussionmentioning

confidence: 64%

“…Pyogenic granuloma (PG) is considered a hyperproliferative vascular response to a variety of stimuli . The first report of PG was made by Poncet and Dor in 1897, and later, Warner and Wilson‐Jones in 1968 reported a series of patients who developed a localized cluster of PGs around the site of an original PG after its surgical removal (localized eruptive PG) …”

Section: Discussionmentioning

confidence: 99%

“…As classic PGs, disseminated eruptive PG presents as lobulated, pedunculated, or sessile benign vascular tumors but with the sudden appearance of multiple widespread lesions . Histopathologic features are capillary lobules separated by fibromyxoid stroma containing scattered spindle‐ and stellate‐shaped connective tissue cells . A superficial lymphocyte‐predominant inflammatory reaction can occur in ulcerated lesions, but inflammation does not seem to be an intrinsic feature .…”

Section: Discussionmentioning

confidence: 99%

“…Histopathologic features are capillary lobules separated by fibromyxoid stroma containing scattered spindle‐ and stellate‐shaped connective tissue cells . A superficial lymphocyte‐predominant inflammatory reaction can occur in ulcerated lesions, but inflammation does not seem to be an intrinsic feature . Collarette of acanthotic epidermis constricting the base of the lesion is a typical finding .…”

Section: Discussionmentioning

confidence: 99%

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Multiple erythematous, shiny papules in a child

2014

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multiple erythematous, shiny papules in a child

2014

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“…Aside from classic solitary mucocutaneous PG, several other clinical variants have been recognized (table 1, right column) [2,3,6,7,8,9,10,11]. ‘Epulis gravidarum' (granuloma gravidarum) is a term reserved for PG arising in the oral mucosa during pregnancy, usually during the second or third trimester of gestation [10].…”

Section: Introductionmentioning

confidence: 99%

Eruptive Disseminated Pyogenic Granulomas following Lightning Injury

et al. 2015

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Background: Pyogenic granuloma (PG) is a common benign acquired vascular tumor. It classically presents as a solitary friable nodule on the face or distal extremities. Disseminated eruption is rare and can occur spontaneously or secondary to various triggers, including burn injury. To date, the literature reports only 13 cases of eruptive PGs following burn injury, most from exposure to boiling milk or water. We report the first case of disseminated eruptive PGs following a lightning injury. Case: A 17-year-old previously healthy boy developed second- and third-degree burns following lightning injury. Two weeks later, he developed widespread dark-purple polypoid exophytic tumors ranging from 1 to 10 cm in diameter extending beyond the limits of the initial burn injury. The lesions were friable and often formed erosions and crusts. The patient was otherwise well and laboratory and microbiological investigations were normal. Excisional biopsy of a lesion was diagnostic of PG and the patient was treated with surgical excision of the lesions, without recurrence. Conclusion: The exact pathogenesis of multiple PGs remains unknown. Several pathogenic mechanisms have been suggested, including production of angiogenic factors that stimulate endothelial proliferation and formation of minute arteriovenous fistulas by trauma.

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Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma

2014

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several months. Our patient was without hydroxyurea for 2 months and showed no improvement. Only after the hydroxyurea therapy was discontinued permanently was her ulcer finally able to resolve with medical and surgical intervention. Another complicating factor in our patient's wound healing was the immunosuppressive effects of the prednisone and azathioprine, which likely led to intermittent superinfection and prevented the ulcer from healing on its own. Why does hydroxyurea cause cutaneous ulceration? Almost all patients taking hydroxyurea develop megaloblastic erythrocytes within 24 hours, causing decreased susceptibility to deformation that impairs capillary blood flow to the skin. 4,5 The result is cutaneous anoxia followed by ulceration. This mechanism may explain why the malleolus, a frequent site of trauma, is a common location for these ulcers. In our patient, the ulcer developed after cryotherapy, which led to skin breakdown and ultimately ulceration. MTHFR polymorphisms, such as the homozygous C→T substitution at nucleotide 677 found in our patient and in 10% to 13% of the white population, can lead to arterial occlusive disease and ulceration. This results from decreased enzyme activity, which causes an increased total homocysteine level in the presence of suboptimal folate intake. 6 The concurrent existence of an MTHFR polymorphism or other thrombophilic genetic mutation in a patient taking hydroxyurea could be the complicating insult that leads to cutaneous ulceration. Therefore, we recommend screening for an array of coagulation abnormalities that predispose to thrombophilia (including MTHFR polymorphisms) in patients with ulcers unresponsive to standard therapy as well as the use of B vitamin supplementation in patients with a MTHFR polymorphism. Future studies looking at MTHFR polymorphisms in patients with hydroxyurea-induced ulcers may solidify this association.

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Agminated, Eruptive Pyogenic Granuloma‐Like Lesions Developing over Congenital Vascular Stains

Abstract: We report three infants who developed agminated pyogenic granulomas over congenital vascular malformations, all of which had an aggressive growth pattern. There were no precipitating events such as laser therapy or surgery. Lesions were excised.

Cited by 27 publications

References 32 publications

Multiple erythematous, shiny papules in a child

Multiple erythematous, shiny papules in a child

Eruptive Disseminated Pyogenic Granulomas following Lightning Injury

Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma

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