Lobular capillary hemangioma, also known as pyogenic granuloma, is a tumor-like, benign reactive, vascular proliferation, essentially an "-oma" of granulation tissue, usually caused by trauma or local irritation. It is not a true neoplastic process. It does not usually suppurate so the term "pyogenic" is a misnomer.
It tends to occur in children and young adults, and 75% occur on the gingiva. However, the labial mucosa, buccal mucosa, and tongue may also be affected. Over time, lobular capillary hemangiomas may sclerose and become more fibrous.
A particular subset occurs in pregnant patients, and this is called "granuloma gravidarum." These occur in the first trimester of pregnancy and grow steady under hormonal influences throughout pregnancy. Post-partum, the lesions tend to become smaller or involute completely. However, many will remain as a smaller, scarred, fibrotic nodule. Patients are aware of an enlarging mass that may bleed easily.
Some abscesses on the gingiva also appear purplish and vascular and develop rapidly. They are always painful and associated with an odontogenic infection.
Metastatic tumors often involve the gingiva, but these generally occur in older patients. Metastatic renal cell carcinomas in particular are quite vascular and may appear as purplish red nodules.
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Lobular capillary hemangioma, also known as pyogenic granuloma, is a common, benign growth that often appears as a rapidly growing, bleeding bump on the skin or inside the mouth. It is composed of blood vessels and may occur at the site of minor injury.
When a lobular capillary hemangioma occurs in a pregnant woman, it is sometimes called a "pregnancy tumor" (granuloma gravidarum). Lobular capillary hemangiomas develop in up to 5% of pregnant women.
Who’s At Risk
Lobular capillary hemangiomas occur in people of all races. Women are more frequently affected by lobular capillary hemangiomas than men, although male and female children are equally affected.
Lobular capillary hemangiomas are most often seen in:
Children and young adults
Pregnant women
Women taking oral contraceptives
People taking certain oral retinoid medications, including isotretinoin or acitretin (Soriatane)
People taking protease inhibitors such as indinavir (Crixivan)
People on chemotherapy
Signs & Symptoms
The most common locations for lobular capillary hemangiomas include:
Lips, gums, and inner mouth (particularly in pregnant women)
Hands and fingers
Head and neck
Feet and toes
Upper trunk
Typically, lobular capillary hemangiomas appear as a beefy, red bump that enlarges rapidly over a few weeks. On average, lobular capillary hemangiomas are about 5-10 mm in diameter. They may bleed easily and, in some cases, can be tender. Very rarely, more than one lesion of lobular capillary hemangiomas may develop at the same time at the same site.
Self-Care Guidelines
See your doctor if you notice any rapidly enlarging skin growth in order to establish a correct diagnosis. Because it is prone to easy bleeding, a lobular capillary hemangioma lesion should be covered with a bandage until you see your doctor.
When to Seek Medical Care
Make an appointment with a dermatologist or another physician if any rapidly enlarging or bleeding growth develops on your skin or in the areas lining your nose or mouth (mucous membranes).
Treatments
If the diagnosis of lobular capillary hemangioma is suspected, your doctor will probably want to perform a skin biopsy. The procedure involves:
Numbing the skin with an injectable anesthetic.
Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6-14 days later.
Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
Lobular capillary hemangiomas that develop in pregnant women often resolve after delivery. Similarly, lobular capillary hemangiomas associated with medications usually improve when the medicine is discontinued or the dosage is lowered. Depending on the size of the lobular capillary hemangioma and its location and symptoms, the doctor may decide that no treatment is necessary for pregnant women or for people who can safely stop or lower the dose of the medication that caused the lesion.
Although lobular capillary hemangioma is a benign condition, it is frequently removed due to its tendency to bleed, its tenderness, and its distressing appearance. However, untreated lobular capillary hemangiomas may go away on their own.
In obvious cases of lobular capillary hemangioma, your physician may choose to treat it immediately after obtaining the biopsy. Such treatments include:
Scraping and burning (curettage and cauterization). After numbing with local anesthetic, the area is scraped with a sharp instrument (a curette) and burned with an electric needle (cautery).
Silver nitrate solution
Topical imiquimod cream (Aldara)
Laser treatment
Freezing with liquid nitrogen (cryotherapy)
Surgical removal (excision)
Approximately 40% of lobular capillary hemangiomas come back (recur) after treatment, especially those lesions located on the trunk of teenagers and young adults. Recurrent lobular capillary hemangiomas are best treated by surgical excision.
References
Bolognia, Jean L., ed. Dermatology, pp.1823-1824. New York: Mosby, 2003.
Patient Information for Lobular capillary hemangioma - Oral Mucosal Lesion