Case Study
Management of a Recurrent Pyogenic Granuloma of the Inferior Lip with Pulsed Dye Laser: A Case Report

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Abstract

Pyogenic granuloma (PG) is a common, acquired, benign vascular reactive proliferation. This article presents the unique and successful pulsed dye laser treatment of a labial PG on a 60-year-old patient.

Introduction

Pyogenic granuloma (PG) is a common, acquired, benign vascular reactive proliferation.1 It was first described by Hullihen in 1844, and the pyogenic granulomatic term was first used by Hartzell in 1904.2, 3 PG typically develops as a erythematous papule on skin or mucosal surfaces. The immediate PG may sometimes be due to long-standing low-grade infections, microtrauma, poor oral hygiene or hormonal impairment.4 Once the underlying cause is removed, the lesion can be surgically excised. However, this modality can cause unexpected complications.5 Lesions may recur up to 16% after surgical excision.5 It is believed that the causes of recurrence are incomplete excisions, the etiologic factor not being removed, or recurrent trauma.5

Pyogenic granuloma usually occurs in the skin and oral cavity as a tumor like lesion. The lesion may bleed spontaneously or due to trauma.5 Although pyogenic granulomas are pathologically benign, they can sometimes lead to destruction in neighboring tissues.6 Initially they are identical to granulation tissue, with numerous capillaries and venules distributed radially to the skin surface in edematous stroma with mixed inflammatory infiltrate. In more advanced stages, fibrous septa partition the lesion into lobules composed of aggregates of capillaries and venules with prominent endothelial cells but no stromal edema and little inflammatory infiltration. Finally, fibroplasia replaces the lobules of capillaries until the lesion transforms into a fibroma.7, 8

Many different treatment modalities other than surgical excision (such as cryotherapy, sodiumtetradecylsulfate, sclerotherapy, intralesional steroid, neodymium-doped yttrium garnet (Nd-YAG), carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet laser) may be used for PG.9, 10, 11, 12, 13, 14, 15 However, the result is often unsatisfactory especially in difficult areas and large lesions.16 This article present a pulsed dye laser treatment of a 60-year-old male patient with a labial PG.

Section snippets

Case

A 60-year-old male patient had a lesion on his inferior labium after a herpetic attack. The lesion was bleeding at intervals for 2 months and the bleeding was severe. The patient's lesion was surgically excised and a biopsy showed pyoderma gangrenosum (Fig. 1). The lesion subsequently recurred after 1 month and continued to bleed intermittently (Fig. 2). Laser photocoagulation was applied to the patient's lesion using pulsed dye laser with parameters of 585 nm wavelength, 5 mm diameter spot

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    Conflict of interest: There is no conflict of interest.

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