Takahiko Tsunoda

Correspondence: Ligation of pyogenic granuloma on a face

Ligation of pyogenic granuloma on a face Editor, Pyogenic granuloma is a common vascular hyperplasia of the skin and mucous membrane that occurs in children and young adults. It often arises at sites of minor trauma, suggesting that it may represent a reactive phenomenon. The lesions are preferentially located on the face, fingers, toes, and trunk. Treatment options are complete surgical excision, electrodesiccation, cryotherapy, or laser surgery. However, it occasionally occurs in young children, in whom treatment can be difficult. Here we report a case of pyogenic granuloma that was treated in a less traumatic way with a simple ligation at the base. A 2-year-old girl was brought to our hospital by her parents who worried about a rapidly enlarging nodule with spontaneous bleeding on the left side of her forehead that first appeared 3 weeks before. A physical examination revealed a well-circumscribed pedunculated nodule, 5 mm in diameter, of reddish color on the left side of her forehead (Fig. 1a). Clinically, we made a diagnosis of pyogenic granuloma. As her parents expressed their preference for atraumatic treatment, we chose ligation of the nodular bottom as the therapy. Without anesthesia, the basal portion was ligated tightly twice with 5-0 surgical nylon suture. The nodule became necrotic and separated from the base after 1 week leaving a small erosion. Five weeks later the lesion healed without noticeable scar formation (Fig. 1b). There has been no recurrence for a year post treatment. Pyogenic granuloma is common in children. We hesitate to perform traumatic therapies in children but need to choose some approach to therapy, because pyogenic granuloma is prone to hemorrhage and spontaneous disappearance is not common. The standard treatment is complete excision and surgical closure, which leaves a cosmetic defect. Ligation can be easily performed even in young children because it is less traumatic. Furthermore, it is suitable for cosmetically important areas such as the face. In addition, it is fast and inexpensive. One problem with this method is the inability to perform pathohistologic examination. The clinical features of pyogenic granuloma may occasionally mimic those of malignant tumors, including malignant melanoma, which suggests that we should treat only clinically obvious cases by this technique. However, careful observation using a dermoscope can be helpful for a correct diagnosis. Another problem in pyogenic granuloma is frequent recurrence, because the proliferating vessels occasionally extend into the deep dermis. Cases with recurrence should be excised surgically. Only a limited number of reports about ligation for pyogenic granuloma have been published, but we think that ligation can be useful for the initial therapy, especially in young children. To determine the efficacy, it is important to accumulate treatment results.

Correspondence: Ligation of pyogenic granuloma on a face: Correspondence

Ligation of pyogenic granuloma on a face Editor, Pyogenic granuloma is a common vascular hyperplasia of the skin and mucous membrane that occurs in children and young adults. It often arises at sites of minor trauma, suggesting that it may represent a reactive phenomenon. The lesions are preferentially located on the face, fingers, toes, and trunk. Treatment options are complete surgical excision, electrodesiccation, cryotherapy, or laser surgery. However, it occasionally occurs in young children, in whom treatment can be difficult. Here we report a case of pyogenic granuloma that was treated in a less traumatic way with a simple ligation at the base. A 2-year-old girl was brought to our hospital by her parents who worried about a rapidly enlarging nodule with spontaneous bleeding on the left side of her forehead that first appeared 3 weeks before. A physical examination revealed a well-circumscribed pedunculated nodule, 5 mm in diameter, of reddish color on the left side of her forehead (Fig. 1a). Clinically, we made a diagnosis of pyogenic granuloma. As her parents expressed their preference for atraumatic treatment, we chose ligation of the nodular bottom as the therapy. Without anesthesia, the basal portion was ligated tightly twice with 5-0 surgical nylon suture. The nodule became necrotic and separated from the base after 1 week leaving a small erosion. Five weeks later the lesion healed without noticeable scar formation (Fig. 1b). There has been no recurrence for a year post treatment. Pyogenic granuloma is common in children. We hesitate to perform traumatic therapies in children but need to choose some approach to therapy, because pyogenic granuloma is prone to hemorrhage and spontaneous disappearance is not common. The standard treatment is complete excision and surgical closure, which leaves a cosmetic defect. Ligation can be easily performed even in young children because it is less traumatic. Furthermore, it is suitable for cosmetically important areas such as the face. In addition, it is fast and inexpensive. One problem with this method is the inability to perform pathohistologic examination. The clinical features of pyogenic granuloma may occasionally mimic those of malignant tumors, including malignant melanoma, which suggests that we should treat only clinically obvious cases by this technique. However, careful observation using a dermoscope can be helpful for a correct diagnosis. Another problem in pyogenic granuloma is frequent recurrence, because the proliferating vessels occasionally extend into the deep dermis. Cases with recurrence should be excised surgically. Only a limited number of reports about ligation for pyogenic granuloma have been published, but we think that ligation can be useful for the initial therapy, especially in young children. To determine the efficacy, it is important to accumulate treatment results.

A Case of Drug Eruption due to a Low Dose Contraceptive

40歳, 女性。月経不順のため, 初診の3カ月前より低用量ピル (トリキュラー®28) を服用していた。1カ月前より体幹, 四肢に痒みを伴う皮疹が出現し, 前医で色素性痒疹として加療したが改善しなかった。初診時, 体幹, 四肢に軽度浸潤を触れる紅斑を地図状に認め, 多形紅斑と考えた。病理組織では真皮上層に多数の好酸球の浸潤を認めた。他に内服中の薬剤はなく, 低用量ピルによる薬疹を考えた。内服中止後, 皮疹はすみやかに消退し, 軽度の色素沈着を残すのみとなった。患者が服用した低用量ピルはエチニルエストラジオールとレボノルゲストレルの2つのホルモン成分からなる。スクラッチパッチテストでは, レボノルゲストレルの濃度が高い剤型で反応が大きかった。コントロールパッチテストはすべて陰性であった。内因性プロゲステロンの皮内テストでは即時型, 遅延型ともに陰性であった。以上より, 本症例は低用量ピル (トリキュラー®28) に含まれるレボノルゲストレルが主たる原因の多形紅斑型薬疹と考えた。ただし, 薬剤の添加物の影響も否定はできなかった。低用量ピルによる薬疹の報告は本症例で2例目である。