Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
2007:73:2;141-141
doi: 10.4103/0378-6323.31912

Cryo-therapy in granuloma pyogenicum

Ramji Gupta, Sarthak Gupta
 Vidyasagar Institute of Mental Health and Neurosciences, Nehru Nagar, New Delhi, India

Correspondence Address:
Ramji Gupta
47-C, Pocket B, Siddharth Extension, New Delhi - 110014
India
How to cite this article:
Gupta R, Gupta S. Cryo-therapy in granuloma pyogenicum. Indian J Dermatol Venereol Leprol 2007;73:141
Copyright: (C)2007 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Granuloma pyogenicum is a vascular lesion composed of proliferating capillaries in a loose stroma. It is due to proliferating small blood vessels coming through a breach in the epidermis. The epidermis forms a collarette at the base of the lesion and covers part or whole of the lesion in a thin layer. [1]

Various modalities available to treat the lesion of granuloma pyogenicun include curettage and cauterization, coagulation of the base with diathermy, excision and sutures, cryo-therapy with liquid nitrogen or nitrous oxide and lasers.

In an earlier communication, [2] two cases of granuloma pyogenicum were treated in single sitting by N2O operated cryo-machine with complete clearance of the lesions without any scar along with 211 cases of various other cryo-responsive dermatoses. In this study the effect of cryo-therapy in nine cases of granuloma pyogenicum is being evaluated.

Twenty patients having 22 lesions of granuloma pyogenicum diagnosed clinically were included in the study. After detailed clinical history, examination and informed consent the lesion (s) was subjected to nitrous oxide (boiling point -94°C) operated, close probe system cryo-machine, worked on Joule Thomson effect. 1-3 freeze and thaw cycle lasting from 5-60 seconds was used as one sitting, which is able to freeze the whole lesion including 1-2 mm surrounding normal skin. The patients were examined every week for any infection or bleeding after cryotherapy. If there was mild or no improvement, cryo was repeated at an interval of 10-14 days. Patients were instructed to put firm pressure on the lesion if there was any bleeding from the lesions.

Of the 20 patients included, there were 12 females and eight males between the age of six to 56 years. Majority of the lesions were located on the face (Nose - 5, cheek - 5, eyelids - 2, forehead -1, pinna -1, scalp -1), rest were present on fingers - 3 and one each on feet, palm, abdomen and chest. The duration of the lesions varied from five days to six years, majority being between one to 12 weeks.

Number of cryo-therapy sittings done was one in 15 patients and two in 5 patients. Two patients developed infection in the lesions after cryotherapy, which was treated with systemic antibiotics. Eight patients were lost to follow-up after the first sitting. The lesions of remaining seven patients healed without any scar except in one who developed a very small fibroma at the site of GP that was subsequently subjected to cryo-therapy and cleared without any trace. Three patients were lost to follow-up after the second sitting, while lesion in two patients showed complete clearance without any scar.

The healing duration after cryo-therapy in GP varies from 9-14 days. However, if secondary infection takes place, it is prolonged to four-five weeks. All the nine patients who showed complete clearance had been followed-up for three months post-treatment period and had showed no recurrence.

Granuloma pyogenicum, a benign vascular proliferative lesion of the skin and mucous membrane is very common in children. The exact cause of the GP is unknown. The possible causes include trauma, infection or preceding dermatoses, [3] Ghodsi et al . [4] in a comparative study between liquid nitrogen operated cryo-therapy and curettage found that curettage needed 1-2 sitting (1.03), while cryo-therapy need 1-3 (1.42) sittings. Other methods used by various workers include cauterization with silver nitrate, [5] sclerotherapy with sodium tetradecyl sulfate and monoethanolamine oleat, [6],[7] ligation, [8] absolute ethanol injection, [9] Dye, Nd: YAG and CO 2 laser, [10],[11],[12] shave excision and laser photocoagulation, [13] micro-embolization, resection [14] and imiquimod [15] with variable results depending upon the skill of the operators and procedures.

In the present series, 12 patients who reported for follow-up after the first sitting of cryo-therapy, seven showed complete clearance without any scar while remaining five required further sitting. Of the five subjected to the second sitting of cryo-therapy, two showed complete clearance, while the remaining three did not turn up for further advice. As we do not know the fate of GP in defaulted patients regarding the clearance of lesions, we have not taken them for evaluation.

With the above data, it is clear that if done properly all the lesions of granuloma pyogenicum can be cleared completely with N2O operated cryo-machine without scar and pigmentation. N2O cryo machine is convenient to carry, easily available, comparatively cheaper and poses no risk to the operator from accidental burning as occasionally seen with liquid N 2 when used directly with swab stick.

The above data suggests that if proper attention is given to this mode of treatment the cure rates are as good as with other modalities available for treatment of granuloma pyogenicum.

References
1.
Mac KI. Soft tissue tumours. In: Textbook of dermatology. Champion RH, Burton JL, Ebling FJ, editors. 5th ed. Blackwell scientific Publications: Oxford: 1992:51:2084-5.
[Google Scholar]
2.
Quitkin HM, Rosenwasser MP, Strauch RJ. The efficacy of silver nitrate cauterization for pyogenic granuloma of the hand. J Hand Surg Am 2003;28:435-8.
[Google Scholar]
3.
Moon SE, Hwang EJ, Cho KH. Treatment of pyogenic granuloma by sodium tetradecyl sulfate sclerotherapy. Arch Dermatol 2005;141:644-6.
[Google Scholar]
4.
Matsumoto K, Nakanishi H, Seike T, Koizumi Y, Mihara K, Kubo Y. Treatment of pyogenic granuloma with a sclerosing agent. Dermatol Surg 2001;27:521-3.
[Google Scholar]
5.
Nishimura Y, Yamamoto Y, Kadota M. Ligation therapy for pyogenic granuloma. Dermatol 2004;31:699-700.
[Google Scholar]
6.
Ichimiya M, Yoshikawa Y, Hamamoto Y, Muto M. Successful treatment of pyogenic granuloma with injection of absolute ethanol. J Dermatol 2004;31:342-4.
[Google Scholar]
7.
Tscharner GG, Hunziker T. Dye laser treatment of periungual pyogenic granuloma. J Dtsch Dermatol Ges 2006;4:141-2.
[Google Scholar]
8.
Hass N, Toppe F, Henz BM, Berlien HP, Algermissen B. Pyogenic granuloma recurring with multiple satellites: Nd: YAG laser treatment with ice cube cooling. Ann Dermatol Venereol 2002;129:433-5.
[Google Scholar]
9.
Raulin C, Greve B, Hammes S. The combined continuous-wave/pulsed carbon dioxide laser for treatment of pyogenic granuloma. Arch Dermatol 2002;138:33-7.
[Google Scholar]
10.
Kirschner RE, Low DW. Treatment of pyogenic granuloma by shave excision and laser photocoagulation. Plast Reconstr Surg 1999;104:1346-9.
[Google Scholar]
11.
Forman D, Goldberg Hl. Microembolization and resection of a highly vascular pyogenic granuloma. J Oral Maxillofac Surg 1990;48:415-8.
[Google Scholar]
12.
Gupta R. Cryo-therapy in dermatology. J Pak Asso Dermatol 1998:8:7-12.
[Google Scholar]
13.
Lin RL, Janniger CK. Pyogenic granuloma. Cutis 2004;74:229-33.
[Google Scholar]
14.
Ghodsi SZ, Raziei M, Taheri A, Karami M, Mansoori P, Farnaghi F. Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma, a randomized trial. Br J Dermatol 2006;154:671-5.
[Google Scholar]
15.
Goldenberg G, Krowchuk DP, Jorizzo JL. Successful treatment of a therapy-resistant pyogenic granuloma with topical imiquimod 5% cream. J Dermatolog Treat 2006;17:121-3.
[Google Scholar]

Fulltext Views
1,247

PDF downloads
1,582
Show Sections