Pyogenic Granuloma in Ten Children Treated with Topical Imiquimod

Abstract

Traditional therapy for pyogenic granuloma is procedural. In young children it can require a general anesthetic and may be complicated by scarring, dyspigmentation, and recurrence. We report a series of 10 children, highlighting the safety and efficacy of topical 5% Imiquimod as an alternative noninvasive treatment of pyogenic granuloma. Ten children with a mean age of 2.5 years and 10.8 week duration of facial pyogenic granuloma lesion were recruited. Treatment regime with topical Imiquimod 5% cream varied in frequency of application and duration according to clinical response. Clinical outcome in the majority of the children was satisfactory. Three had no evidence of disease and five had small hypopigmented or erythematous lesions which were continuing to improve and more acceptable then a surgical scar. One child required a prolonged treatment course, and one progressed to surgical excision when prolonged treatment failed. There were no systemic side effects noted in any of the patients and no recurrence noted with resolution sustained over an average of 9.6 months of follow-up. Imiquimod is a safe, cost-effective, and clinically effective management option in the treatment of pyogenic granuloma.

Therapeutic approaches to pyogenic granuloma: an updated review

“…Nine out of ten patients achieved almost complete response to treatment in a mean duration time of 2–17 weeks, while only one patient had to undergo surgery for complete resection of the lesion. No sign of recurrence was seen in a 9.6‐month follow‐up, while the cosmetic result was also very satisfactory for the patients, since no scarring was observed . Similar results demonstrating the efficacy of 5% imiquimod cream with similar application schedules are also to be found on case reports and case series .…”

“…As far as topical, non‐invasive regimens are concerned, 5% imiquimod seems to be a safe option for both adult and pediatric patients . In a study of Tritton et al ., 10 pediatric patients were treated with local 5% imiquimod cream.…”

Imiquimod in dermatology: an overview

“…Anecdotal case reports also showed resolution of several other vascular tumors such as pyogenic granuloma, epithelioid hemangioendothelioma, angiolymphoid hyperplasia with eosinophilia, and lymphangioma circumscriptum with imiquimod treatment.…”

“…Since an initial report showing imiquimod's potential in accelerating infantile hemangioma (IH) regression, more evidence have emerged on the efficacy of imiquimod in the treatment of several cutaneous vascular tumors or disorders including Kaposi's sarcoma (KS), pyogenic granuloma, among others . Imiquimod‐induced regression of vascular tumors is probably mediated by its immunomodulatory and anti‐angiogenic effects…”

Pyogenic granuloma, port-wine stain and pregnancy

“…13 Topical 5% imiquimod has also been successfully used in treating pyogenic granuloma. 4 We consider that the best therapies should allow for histological confirmation, hence providing diagnostic certainty and preventing inappropriate treatment of other tumours.…”