Pyogenic granuloma — hypotheses of etiopathogenesis, clinical forms and features, modern diagnostic methods and choice of rational treatment tactics

Abstract

Objective — to analyze modern hypotheses of etiopathogenesis and clinical features of pyogenic granulomas (PG) and to determine the importance of ultrasound of these neoplasms for the choice of individualized tactics of their treatment, taking into account the stage of tumor proliferation. Materials and methods. During 2020—2022, 94 patients with a diagnosis of «pyogenic granuloma» (PG) underwent outpatient treatment under our supervision at Dr. Bogomolets Institute of Dermatology and Cosmetology (Kyiv). The largest number of patients with PG examined by us was aged from 1 to 12 years (72 %), which correlates with the data of scientific research by other authors on the relevant problem. Anamnesis was collected in all examined patients (according to the patients and their parents) regarding the possible causes of neoplasms and the nature of their development. All the patients underwent a complex diagnostic instrumental examination of PG (dermoscopy, ultrasound, histopathology). The choice of treatment tactics was carried out individually in each specific clinical case, taking into account the results of the examination and the stage of tumor proliferation (radio wave removal or treatment with a 595­nm pulsed dye laser was carried out). Results and discussion. A total of 94 patients with PG were examined and treated on an outpatient basis. By age, children from 1 to 8 years old (48 %) and from 8 to 12 years old (24 %) prevailed among the examined. There were 6 % of teenagers and young adults (12—18 years old), 22 % over 18 years old. In 45 patients, neoplasms were localized on the skin of the face, in 7 — on the neck, in 9 — on the upper limbs, in 6 — on the lower limbs, in 27 — on the skin of the trunk. In 87 clinical cases, radio wave removal of neoplasms with their subsequent pathohistological diagnosis was carried out taking into account the results of a comprehensive examination of patients with PG, including the data of ultrasound of the skin in the areas affected by PG, which makes it possible to determine the depth of tumor invasion together with the exophytic part. In 6 clinical cases, PG removal therapy was selected and performed using a pulsed vascular dye laser with a wavelength of 595 nm. In one clinical case, taking into account the sufficiently large size of the tumor (more than 2 cm) and the significant vascularization of the neoplasm revealed by ultrasound, a diagnostic excisional biopsy was performed within healthy tissues. Recurrences of PG after treatment were observed after 2 months in 2 of 94 patients, in particular, after pulsed vascular laser therapy. Subsequently, in these two patients, PG was removed using the radio wave method. No recurrences of the disease were registered. Conclusions. The analysis of modern literature on the problem of PG and the results of own clinical observation and treatment of patients with the corresponding neoplasms indicate that ultrasound of these skin tumors is a sufficiently informative and promising diagnostic method that allows identifying the stage of proliferation and choosing the rational individualized treatment tactics. Considering that the use of ultrasound of skin tumors is a relatively new methods in dermatology, further research in the relevant direction is appropriate, which will increase its diagnostic informativeness.