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Year : 2018  |  Volume : 19  |  Issue : 4  |  Page : 351-353

Recurrence of scalp pyogenic granuloma with satellitosis in 4.5-Year-Old Boy

Molecular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Date of Web Publication28-Sep-2018

Correspondence Address:
Dr. Nahid Hemmatian Boroujeni
Molecular Research Center, Shiraz University of Medical Sciences, Shiraz
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpd.IJPD_107_17

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The patient was 4.5-year-old boy presented by an erythematous nodule in occiput that bleeds easily. He sought medical attention, and after each session of treatment, several nodules appear adjacent to the first lesion. Pyogenic granuloma (PG) recurrence at the site of treatment can occur, but satellitosis is a rare complication. PG satellitosis usually occurs in the site of pressure or trauma, but the patient did not mention any history of trauma.

Keywords: Pyogenic granuloma, recurrence, satellitosis

How to cite this article:
Jowkar F, Boroujeni NH, Hoseinpour S, Aslani FS. Recurrence of scalp pyogenic granuloma with satellitosis in 4.5-Year-Old Boy. Indian J Paediatr Dermatol 2018;19:351-3

How to cite this URL:
Jowkar F, Boroujeni NH, Hoseinpour S, Aslani FS. Recurrence of scalp pyogenic granuloma with satellitosis in 4.5-Year-Old Boy. Indian J Paediatr Dermatol [serial online] 2018 [cited 2020 Oct 23];19:351-3. Available from: https://www.ijpd.in/text.asp?2018/19/4/351/242405

  Case Report Top

The patient was 4.5-year-old boy with multiple erythematous nodules and small papules in his right side of occiput [Figure 1]. First lesion was an erythematous nodule that bleeds easily since 1 year of age. He did not mention any history of trauma or irritation in this site before the appearance of first lesion. Several treatments such as cautery, laser and excision were done for the patient before he came to our clinic. The patient had biopsy with differential diagnosis PG, and hemangioma pathologic evaluation reveals lobulated proliferation of closely packed capillary sized vessels with overlying thin epidermis in association with collarets at the margins of vascular proliferation [Figure 2] and [Figure 3]. Histopathology confirmed diagnosis of pyogenic granuloma (PG). After each treatment, several nodules appeared in and around the site of previous treatment.
Figure 1: Several erythematous nodules and papules in the right side of occiput. The lesions bleed easily

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Figure 2: Lobular vascular proliferation and collaret at the margins of vascular proliferation (H and E, ×40)

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Figure 3: Proliferation of capillary-sized vessels with overlying thin epidermis.(H and E, ×100)

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  Discussion Top

PG is a misnomer because it is neither infectious nor granulomatous. It is a benign vascular proliferation that can be named by telangiectatic granuloma, eruptive hemangioma, granulation tissue-type hemangioma, granuloma gravidarum, lobular capillary hemangioma, and pregnancy tumor.[1] PG is a benign vascular lesion that can be seen both in oral mucosa or skin.[2] In clinical examination, peripheral collaret of scale and bleeding tendency were highlighted. It presents as a red-to-violaceous papule or nodule that can be pedunculated or sessile. PG bleeds easily; so, sometimes, it was seen as a crusted or ulcerated papule or nodule. Cutaneous PG incidence is equal between both sexes but oral PG is higher rate of occurrence in female.[3] There are several etiologies for PG such as chronic low-grade irritation, traumatic injury, hormonal factors and pregnancy (because of it, one of its name is granuloma gravidarum), microscopic arteriovenous malformation, drugs (such as retinoid, antiretroviral, and oncologic drugs),[4] burns,[5] localized viral infections, insect bites, and iatrogenic stimulations such as PG after dental procedure. When PG was present, trauma and pregnancy can accelerate its growth rate.[6] Size of PG can vary but usually is not beyond 2 cm. With excision, recurrence rate was 16% to 50%. Etiologies of recurrence are shown in [Table 1].[2]
Table 1: Most common cause of pyogenic granuloma recurrence

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PG recurrence is common but recurrence with satellitosis is an uncommon finding.[3] PG has a benign nature and sometimes resolves spontaneously, but its appearance and bleeding tendency put pressure to patient and his/her doctor to choose a treatment method.[7] Satellite PG can appear with or without appearance of primary lesion after each treatment. There is no need always to have irritation, as sometimes this occurred in patients younger than 25 years.[6]

Most PGs with satellitosis were in children and young adults, and site of lesions were in trunk, especially over the scapula.[7] If recurrent PG appears within or in the periphery of previous treatment scar in a course of 1–4 weeks after the treatment, you can note it as recurrent satellitosis.[2] Recurrence of PG can delay up to 4 years after treatment. Recurrence with satellitosis is seen mostly in children.[8] Density of satellite lesions nearby the scar of treatment is high. When we came far from the scar of pervious treatment, satellite lesion became smaller and sparse.[7] Some authors proposed that topical pressure to a primary PG is the etiology of satellitosis. However, exact etiology and pathogenesis is not clear. Maybe trauma with increase in proangiogenic factors such as vascular endothelial growth factor is the pathogenesis of this reaction.[8]

Differential diagnoses for PG are amelanotic melanoma, bacillary angiomatosis, Kaposi sarcoma, and angiosarcoma.[8] Bacillary angiomatosis must be in mind when recurrent lesion was seen in HIV patient.[7] Bacillary angiomatosis can be excluded with lake of bacilli in pathology of PG. Kaposi sarcoma and angiosarcoma in standpoint of pathology are between differential diagnoses. None of these two entities have lobular arrangement of capillaries that is typical for PG.[3]

Treatment modalities for PG satellitosis are destructive methods such as surgical excision, curettage, pulsed dye laser, systemic steroids, cryotherapy, chemical and electric cauterization, radiotherapy, intense pulse light, sclerotherapy with ethanolamine oleate, and various type of lasers.[3]

  Conclusion Top

PG is a benign lesion but we need to choose a therapeutic modality due to cosmetic concerns. These patients need follow-up for further recurrences. The patient has an atypical site for PG and of course satellitosis. Previously, Edward Wilson reported 14 cases with atypical site of PG in ear and occiput. Three of them were in occiput, and they were adult women.[9] Parent of the patient denies any history of previous trauma, but after each destruction, recurrence with satellitosis was occurred. However, in our follow-up after destruction with CO2 laser into depth of dermis combined with intradermal steroid injection, they do not recur.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parents have given consent for images and other clinical information to be reported in the journal. The patient's parents understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Newadkar U. Telangiectatic granuloma, a misnomer for pyogenic granuloma: A case report and review. Univers Res J Dent 2016;6:45-7.  Back to cited text no. 1
Rana R, Ramachandra SS, Prasad UC, Aggarwal P, Dayakara JK. Recurrent pyogenic granuloma with a satellite lesion. Cutis 2015;96:E27-30.  Back to cited text no. 2
Gupta V, Mridha AR, Sharma VK. Pediatric dermatology photoquiz: Multiple erythematous papules on the back. Recurrent pyogenic granulomas with satellitosis. Pediatr Dermatol 2016;33:97-8.  Back to cited text no. 3
Sammut SJ, Tomson N, Corrie P. Pyogenic granuloma as a cutaneous adverse effect of vemurafenib. N Engl J Med 2014;371:1265-7.  Back to cited text no. 4
Dastgheib L, Maghami Z, Aslani FS. Infantile multiple large pyogenic granuloma on burned skin. Case report and review of literature. An Bras Dermatol 2016;91:212-4.  Back to cited text no. 5
George SM, Gossain SR, Morrison IK, Coburn PR. Recurrent pyogenic granuloma with satellitosis. BMJ Case Rep 2012;2012:pii: bcr1120115162.  Back to cited text no. 6
Tursen U, Demirkan F, Ikizoglu G. Giant recurrent pyogenic granuloma on the face with satellitosis responsive to systemic steroids. Clin Exp Dermatol 2004;29:40-1.  Back to cited text no. 7
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: A review. J Oral Sci 2006;48:167-75.  Back to cited text no. 8
Jones EW, Bleehen SS. Inflammatory angiomatous nodules with abnormal blood vessels occurring about the ears and scalp (pseudo or atypical pyogenic granuloma). Br J Dermatol 1969;81:804-16.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]


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