What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced Granulation Tissue-Type Hemangioma
• Drug-Induced Eruptive Pyogenic Granuloma
• Medication-Induced Pyogenic Granuloma

What is Drug-Induced Pyogenic Granuloma? (Definition/Background Information)

• Pyogenic Granuloma is a common benign tumor involving the blood vessels observed commonly on the mouth or skin. These tumors may be single or multiple and may grow rapidly
• Drug-Induced Pyogenic Granuloma is caused by the use of certain drugs, such as indinavir, oral contraceptives, cyclosporine, and many other. It may not be considered as a tumor, but as a reactive condition by the body
• Stopping or discontinuing the use of such medications may decrease progression of the condition. Nevertheless, Drug-Induced Pyogenic Granuloma may be removed surgically through a simple excision
• The prognosis of Drug-Induced Pyogenic Granuloma is excellent with suitable treatment

Who gets Drug-Induced Pyogenic Granuloma? (Age and Sex Distribution)

• Drug-Induced Pyogenic Granuloma is a skin condition caused by a variety of medications (that are administered for other underlying conditions). Any individual may be at risk for Drug-Induced Pyogenic Granuloma
• It can affect both males and females
• There is no predilection to any ethnic group or a particular race; the condition is observed worldwide

What are the Risk Factors for Drug-Induced Pyogenic Granuloma? (Predisposing Factors)

The key risk factor for Drug-Induced Pyogenic Granuloma is the administration of certain drugs that cause the condition (tumor growth on the skin or mouth) as a side effect. The drugs commonly observed to induce this overgrowth include:

• Indinavir
• Oral contraceptives
• Cyclosporine
• Accutane
• Anticonvulsant medication such as carbamazepine
• Tyrosine kinase inhibitors (TKIs)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Pyogenic Granuloma? (Etiology)

The exact cause of Drug-Induced Pyogenic Granuloma is presently unknown.

• The condition can be defined as an adverse reaction of the body to certain medications that are taken for various conditions. This results in the formation of lesions on the skin and mucus membranes of the body
• Sometimes, the appearance of signs and symptoms due to the drug may not be observed immediately

What are the Signs and Symptoms of Drug-Induced Pyogenic Granuloma?

The signs and symptoms of Drug-Induced Pyogenic Granuloma may include:

• They are usually present as well-defined, raised, single or multiple tumors; some may be asymptomatic
• Some tumors may grow fast and then stabilize in size; they can become smaller and disappear completely
• Pyogenic granulomas may range in size from 0.5-2.5 cm; large tumors may be painful
• Most common locations of the tumors are the skin and mouth (oral mucosa)
• The tumors may ulcerate and ooze or bleed; scratching these tumors may increase bleeding
• Difficulty in chewing or swallowing, if the ulcer is present in the mouth (gums or cheek)

How is Drug-Induced Pyogenic Granuloma Diagnosed?

A diagnosis of Drug-Induced Pyogenic Granuloma is made using the following tools:

• A complete physical examination and a thorough medical history (which includes the use of any drugs) are very important
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• A tissue biopsy of the tumor: A tissue biopsy is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together the clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be the gold standard, in arriving at a conclusive diagnosis
• Differential diagnosis, to eliminate other tumor types are often considered, before arriving at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Pyogenic Granuloma?

The complications from Drug-Induced Pyogenic Granuloma could include:

• Recurrence of the tumor after incomplete surgical removal
• Sometimes, after treatment, multiple small tumors may arise in the region, which are called satellite nodules of Pyogenic Granuloma
• Bleeding and ulceration of the lesions can cause secondary bacterial or fungal infections to develop
• Some individuals may feel stressed due to the presence of these tumors, or due to the cosmetic issues they create

How is Drug-Induced Pyogenic Granuloma Treated?

Treatment measures for Drug-Induced Pyogenic Granuloma include the following:

• Discontinuing the medication responsible for the side effect may result in a cure, or in improvement of the condition
• A simple surgical excision with removal of the entire lesion is the preferred treatment method. If the tumor is not fully removed, then it might recur
• A laser surgery can help reduce scar tissue formation
• If there are secondary infections, then it may be treated with antibacterial and antifungal medications
• Post-operative care is important: A minimum activity level is to be ensured, until the surgical wound heals
• Follow-up care with regular screening and check-ups are important

How can Drug-Induced Pyogenic Granuloma be Prevented?

It may not be possible to prevent Drug-Induced Pyogenic Granuloma occurrence. However, the following may be considered:

• Stopping the medication causing the condition as early as possible is important. The healthcare provider may prescribe alternative medications to treat the existing, underlying condition
• Periodic monitoring or follow-up of the condition with the healthcare provider is recommended
• It is important to not pick or scratch the lesions, which can help decrease complications
• Maintaining good oral and personal hygiene may be helpful, which includes regular brushing and flossing of one’s teeth

What is the Prognosis of Drug-Induced Pyogenic Granuloma? (Outcomes/Resolutions)

• The prognosis of Drug-Induced Pyogenic Granuloma is excellent with adequate treatment
• Prompt treatment and early recognition will help in arriving at optimal outcomes

Additional and Relevant Useful Information for Drug-Induced Pyogenic Granuloma:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/cancer/