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
Images in Dermatology
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
Media and news
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
Images in Dermatology
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
Media and news
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:

Observation Letter
87 (
6
); 854-855
doi:
10.25259/IJDVL_614_20
pmid:
34623060

Pyogenic granuloma-like lesions due to antifungal-corticosteroid combination creams

Department of Dermatology & STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Corresponding author: V. Ramesh, Department of Dermatology & STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. weramesh@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ramesh V. Pyogenic granuloma-like lesions due to antifungal-corticosteroid combination creams. Indian J Dermatol Venereol Leprol 2021;87:854-5.

Sir,

Three men between 40 years and 55 years of age presented with eruptions in the groins of one to two months’ duration. They had suffered from repeated episodes of tinea cruris in the past one year. Topical fungicidal creams were used by all for around six weeks with clinical improvement and resolution, but the lesions would recur within one or two weeks (even after using different antifungal preparations). When the episodes lasted over many months, the physician prescribed them combination creams containing mid-potent or potent corticosteroids - beclomethasone, betamethasone and clobetasone. No oral antifungal agents were given. After early relief, they started applying the steroid-containing combination creams on their own, barely noticing the development of striae. The onset of some new eruptions along the striae made them seek advice from the dermatologist.

On examination, circumscribed, sessile and eroded papules of varying diameter from 2-5 mm were seen in the inguinal folds, predominantly along the striae, one or more on either side or both. In one patient with a longer duration of lesions, the skin around the papules was hyperpigmented [Figure 1]. The diagnoses considered included pyogenic granuloma, iatrogenic ulcers and secondary syphilis. Biopsy was done in two patients. Histopathology showed irregular acanthosis with ulceration; the dermis revealed proliferating blood vessels of varying sizes amidst fibrotic collagen along with edema and acute and chronic inflammatory cells [Figures 2a and b]. Periodic acid– Schiff stain for fungus was negative. The histopathological features were of non-lobular capillary hemangioma simulating granulation tissue. Blood investigations including venereal disease research laboratory test was negative in all. Combination creams were strictly withheld. Oral terbinafine 250 mg daily, potassium permanganate soaks and topical betadine were advised. Four weeks later, resolution of the lesions was seen. The patients were asked to continue therapy for two more weeks after which topical fungicides were added.

Tiny lesions arising along striae
Figure 1:
Tiny lesions arising along striae
Histopathology showing epidermal acanthosis and ulceration (H&E, ×200)
Figure 2a:
Histopathology showing epidermal acanthosis and ulceration (H&E, ×200)
Proliferating vessels amidst fibrotic collagen (H&E, ×400)
Figure 2b:
Proliferating vessels amidst fibrotic collagen (H&E, ×400)

The current spate of dermatophytic infections in India has transmogrified into an aggressive dermatosis defying available antifungal remedies. Recently, a conference was held, attended by national and international experts devoted exclusively to assess this evolving diabolical trend and plan future studies, the proceedings of which have been published.1Meanwhile, physicians and patients have been battling the situation since the recommended therapy has consistently failed. The patients in this report were otherwise healthy and had tinea cruris which responded to topical antifungals but always recurred. Hence, they were given antifungal creams combined with corticosteroids. Analysis of the clinical studies shows that combination products preferably containing a low potency non-fluorinated corticosteroid were prescribed earlier as an initial therapy to tackle the inflamed lesions, never exceeding two weeks in tinea cruris after which only antifungals were continued.2

However, in this case, following initial relief, the patients continued applying the creams unsupervised, causing development of striae, followed by pyogenic- granuloma like eruptions. Unlike the lobular capillary pattern seen in a typical pyogenic granuloma on histopathology, a reparative vascular phenomenon is seen here (similar to granulation tissue), clinically simulating pyogenic granuloma.3 Steroid-induced epidermal and dermal atrophy4 lead to striae formation and continued application could have resulted in breaks in the weakest areas causing exposure of the underlying fibrovascular contents, resembling pyogenic granuloma. Like intermammary areas, the inguinal areas are susceptible to topical corticosteroid-induced ulcers due to thin skin, elevated temperature, moisture and occlusion of the opposing surfaces.5 Such lesions in diseased skin have also resulted from topical retinoid-induced skin fragility and changes in the connective tissue.6 Since pyogenic granuloma is now synonymous with lobular capillary hemangioma, such lesions may be better termed pyogenic granuloma-like tissue reactions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . Dermatophytosis: Fighting the challenge: Conference proceedings and learning points. September 2-3, 2017, PGIMER, Chandigarh, India. Indian Dermatol Online J. 2017;8:527-33.
    [CrossRef] [PubMed] [Google Scholar]
  2. . Topical therapy for dermatophytoses: Should corticosteroids be included? Am J Clin Dermatol. 2004;5:375-84.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Pyogenic granuloma of the oral cavity: Comparative study of its clinicopathological and immunohistochemical features. Pathol Int. 2005;55:391-7.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , . Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5:416-25.
    [CrossRef] [PubMed] [Google Scholar]
  5. . Ulceration of breast's skin due to topical corticosteroid abuse. J Dermatol Res Ther. 2017;1:36-9.
    [CrossRef] [Google Scholar]
  6. , . Pyogenic granuloma-like lesions in a patient using topical tretinoin. Australas J Dermatol. 1998;39:248-50.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
6,732

PDF downloads
1,643
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections