To provide standardised guidance for the initial management and onward referral pathways for pyogenic granulomas.
Patients presenting to RHC with a pyogenic granuloma
Pyogenic granulomas (PG) are a common benign vascular lesion in children. These have a friable surface and bleed easily. They not infrequently present to the ED if bleeding. Sometimes bleeding is very intermittent and low volume and sometimes it is profuse and frequent.
Where possible PG should be managed conservatively with dressings and subsequent urgent referral for review with the paediatric dermatology team or plastic surgery team. We aim to provide this within 10 working days if urgent review required, taking into account reduced availability of face to face clinics in RHC. If topical Timolol is initiated a later review may occur in order to assess response.
The dermatology team at RHC in Glasgow is small and not always on site. Dermatology at RHC runs only one booked surgical list per month with limited access to ad hoc surgery. This is a local anaesthetic list and not appropriate for children under 8 years or for removal of lesions that are large (>5mm) or on digits. It is also not appropriate if a lesion is bleeding frequently.
The Plastic surgery have regular GA emergency lists and referral to them is appropriate for lesions in children under 8 years, lesions on digits and lesions >5mm. It is also appropriate for lesions which are bleeding frequently and need urgent removal.
GGC Paediatric Guidelines