Pyogenic granuloma

The pyogenic granuloma is a benign tumor composed of an angiogenic capillary proliferation that often appear in areas of friction or trauma.

It usually has a pedunculated appearance with an intense red coloration.

In the foot it is usually associated with onychocryptosis. Although it is not a very frequent alteration, it sometimes appears in ingrown nails of a long time of evolution. It can reach the size of a pea and is easy to distinguish from the rest of the inflamed nail lip.

Bleeds easily due to lack of epithelial lining.

It is important to distinguish it from other types of tumors that can also be located in the area surrounding the nail (periungual area).

Causes of pyogenic granuloma

The cause of pyogenic granuloma is related to the repeated aggression in a certain area of ​​the skin of the body.

Formerly, the cause of pyogenic granuloma was related to the infectious processes of the skin. Even its name suffers from this motif (pyogenic) in allusion to the bacterial flora of the skin.

At present it has been shown by histological analysis that the formation of the pyogenic granuloma is not related to a dermal infection. Surely this belief is justified by the infections that were sometimes located in the breast or around the lesion.

It appears that the mechanism that produces the pyogenic granuloma is a repeated trauma to the skin. The more or less superficial wound of the dermal epithelium will be repaired by the body by scar tissue composed mostly of fibrous tissue.

If during the repair mechanism there is an increase in the proliferation of terminal blood vessels, the formation of a granuloma can begin.

With the passage of time, as the dermal repair processes are repeated, the granuloma is formed. In the case of the ingrown nail, the wound caused by the nail on the nail lip initiates the body’s repairing process in an attempt to solve the damage caused.

However, skin closure is made difficult by invasion of the nail spicule into the nail edge wound. If the problem lasts over time and the nail is not removed from the nail edge, the granulation tissue of the wound will gradually hypertrophy until it forms a granuloma.

Normally these tumors lack an outer layer that surrounds them like epithelium, so they bleed easily with the simple touch of the sock.

What symptoms appear?

Normally the pyogenic granuloma does not hurt but we are going to find the symptoms of the ingrown nail plus that of the granuloma itself:

• Nail pain, more localized on the nail side. The pain is exacerbated if we press this area but also by pressing directly on the nail plate we increase the pain, because we also press the nail together towards the surrounding tissues.
• Inflammation and redness of the tissues around the nail. The skin of the finger appears flushed in the area near the nail, and especially on the nail edges. Finger coloration can vary from deep red to purplish.
• Infection of the nail edge with the formation of pus, which can come out due to the explosion of the abscess.
• Small, pea-sized, reddish growth on the nail edge.
• Inability to put on shoes or tight socks or stockings.
• Sometimes the socks appear stained with blood in the area of ​​the ingrown toenail, due to the ease with which the granuloma bleeds.

How is it diagnosed?

The exact diagnosis of pyogenic granuloma can only be made by histological study of the lesion. For this purpose, the tumor is surgically excised and the tumor is referred to the pathologist.

In the histological analysis, we found a superficially localized vascular proliferation in the dermis. This proliferation consists of a new formation of capillaries surrounded by a simple layer of endothelial cells.

It is important to differentiate pyogenic granuloma from other periungual tumors such as malignant melanoma , squamous cell carcinoma, glomus tumor, or simple post-traumatic granulation tissue.

Pyogenic granuloma treatment

Treatment of pyogenic granuloma is surgical excision of the lesion. It is usually associated with the surgical intervention that is used to solve the problem of the ingrown toenail. The most used technique is the Phenol-Alcohol technique, which consists of applying carbolic acid to the nail edges, once they have been removed. This technique achieves a good aesthetic result and a painless postoperative period, which allows the patient to quickly return to normal life. In the case of pyogenic granuloma, excision of the granuloma with a scalpel is added. The lesion is referred to a pathological study for its exact diagnosis.

Electrocoagulation or silver nitrate can also be used to try to reduce or eliminate it.

How can I avoid it?

The best prevention to avoid the formation of the pyogenic granuloma is to go to the podiatrist whenever we have an ingrown toenail. If we maintain the problem for a long time, it is possible that the granuloma formation process begins.

On the other hand, it is necessary to follow the advice to avoid the nail ingrowth problem, which basically consists of:

• Cut the nail straight without rounding it at the edges and avoiding going deep into the sides of the nail. We must always see that the nail is free and that it is not hidden in the nail canal.
• Use a suitable instrument for cutting the toenails, such as nail clippers or specific pliers for this. Avoid using scissors and especially if they have a point.
• Do not trim the cuticles that surround the nail, since we can cause a wound on the finger that can become infected.
• Do not pick the nail with your fingers or pull any spike. Use a cutting instrument to remove it.
• Do not wear a pointed toe shoe that compresses the foot.
• Do not wear tight socks or stockings that compress the tip of the foot.
• Control the excessive sweating of the feet with the use of a specific antiperspirant. Wear yarn, wool or cotton socks and avoid wearing synthetic socks or stockings.
• If I have difficulty cutting my toenails, see a specialist to do it.
• If you practice a sport that predisposes you to hitting your fingers, wear suitable footwear and control any nail problem by going to a specialist to solve it.

Go to the doctor

If you suffer from any type of pain in the nail that a priori you cannot identify, go to a specialist to examine it and identify the cause of the problem.

If the nail has been nailed, do not try to solve the problem yourself, see a specialist as soon as possible to solve it. This will avoid infections and added problems.

If your nail is curved or in the shape of a tile, go to the specialist to have it cut and try to educate it, preventing it from being nailed.

If you have limitations in bending or have impaired vision, see a specialist to cut your nail.

If the nail is very thick or hard, go to the specialist to cut and cut it.

In case of infection and presence of pus, you should see a specialist urgently to avoid complications and worsening of the condition.