Treatment for Pyogenic Granuloma after Burns: A Retrospective, Single-Center Study Involving 15 Cases

Pyogenic granuloma after burns (PGB) was first reported in 1978. Although the precise etiology of PGBs remains unclear, it is known that second-degree burns1 play important roles in the pathogenesis of pyogenic granuloma. An increasing number of PGB cases have been reported and various therapy plans have been used throughout the world including China. The diagnosis of PGB is similar to that of classic pyogenic granuloma which depends on history, clinical features, and histological examination. Treatment methods for PGB included only conservative treatment, electrocoagulation, and full-thickness excision. Some lesions healed with full-thickness excision and electrocoagulation, whereas the other lesions healed with conservative treatment. Therefore, doctors experience confusion on deciding which treatment to use for PGB cases. Because PGB is rare, it is impossible to clinically assess PGB using a random control trial to compare various treatment options. Thus, we present a single-center retrospective study of 15 cases. These experiences are important and helpful for the treatment of PGB cases. We retrospectively reviewed 21 consecutive patients with PGB, who were treated at the First Hospital of Shijiazhuang between January 1, 2003, and December 31, 2013. Ethics approval for this study was obtained from the ethical committee of the First Hospital of Shijiazhuang, and prior consent was obtained from each patient or their caregiver. The diagnosis of PGB included history, clinical features, and histological examination. The following data were also collected from each patient: age at diagnosis, gender, total body surface area burned, treatments, and outcome. Cases with incomplete or missing data were excluded. Patients were consulted by telephone and followed up for at least six months. The major exclusion criteria include without histological examination, or incomplete data. Patients who lost to follow-up were also excluded. Six cases with incomplete data (three cases) or lost to follow-up (two cases) were excluded. The remaining 15 cases included eight children and seven adults. The male-to-female ratio was 10:5. The patients’ ages ranged from 1 to 58 years. The mean/ median age of these patients was 19.13/4 years. The patients had second-degree burns, including nine cases of scalding, four cases caused by flames, and two cases of burns due to a 380-V electric spark. The total burn surface area of these cases ranged from 1 to 8 per cent. The mean/median total burn surface area values were 4.13/3 per cent. The whole process of PGBs could include proliferating and regressing stage. In proliferating stage, PGBs erupt and enlarge quickly over the burned area of patients’ bodies after one to three weeks. The PGBs ranged in size from 1 · 0.5 to 20 · 26 cm. The lesions were red or brown. The shape included granular, vascular tumor-like or polypoid-like lesions. Most lesions were soft and exhibited bleeding surface lesions. These PGBs were located on the face, trunk, or limbs. In the regressing stage, the lesions became black and brown, and the surface of PGBs dry. PGBs shrank gradually until they regressed completely. The mean of duration of PGBs was 43.9 ± 22.73 days. The mean hospital stay was 21 ± 2.74 days. The mean follow-up of cases was eight months. Ten PGB cases healed completely with conservative treatment. Three cases received fullthickness excisions, including two cases of grafting and one case using primary closure. Two cases received shave excisions with complete healed. No postoperative recurrence was noted, with the exception of one patient with PGBs who recurred seven days Address correspondence and reprint requests to Cuiping Zhang, M.D., Key Laboratory of Tissue Repair and Regeneration of PLA and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration, First Hospital Affiliated to General Hospital of PLA, 51 Fucheng Road, Haidian, Beijing, China 100048. E-mail: zcp666666@sohu.com. This study was supported in part by the National Nature Science Foundation of China (81571905, 81721092) and the National Key R&D Program of China (2017YFC1103304).