Pyogenic Granuloma

Pyogenic granulomas are common skin lesions that appear as tiny red bumps. These lesions have moist, shiny and smooth surface and are prone to bleeding quite often. They tend to bleed frequently as they contain large number of blood vessels at the site. These bumps are usually attached to the skin with stalk. The diameter of the stalk always measures lesser compared to the tumor. Pyogenic granulomas most often occur in children and young adults. It is also common in pregnant women and hormonal changes that take place during pregnancy is said to be the reason for developing Pyogenic granulomas during such period.

Causes and Symptoms

The exact cause for pyogenic granuloma is not known. However it normally occurs at the site of injured or damaged skin. This condition is neither hereditary nor is it contagious.

• A small red raised bump on the skin that bleeds frequently.
  
• They are benign and tend to erupt and grow at a rapid pace.
  
• Usually occurs on hands, arms, and face. In rare cases, they can grow on the cornea of the eye. However pregnant women often develop them on the oral mucosa.
  
• The lesion can measure from few millimeters to several centimeters and there could be single lesion or tiny multiple bumps clustered around the same area.

Pyogenic granulomas is normally diagnosed on mere observation during the clinical examination. A biopsy may be performed to confirm the diagnosis.

Treatment

Pyogenic granulomas may shrink, dry up and fall off on their own over a period of time. Yet the condition most often requires medical attention and treatment much before that; as the wait may be painful and distressing. Pregnant women need not opt for any treatment as the lesions disappear after delivery. In normal cases the following methods are usually followed to treat Pyogenic granulomas.

Curettage: Curettage is always known to be the first line treatment for Pyogenic granulomas. Curettage involves scraping of the lesion with a curette, a spoon like instrument with sharp edges. Once the lesion is removed, Electro cauterization is performed to avoid regrowth and prevent infection.

Cryotherapy: Cryotherapy involves freezing the lesion using liquid nitrogen. This method is effective in treating small lesions. Cryotherapy does not leave a deep scar. However it may change the color of the skin at the site.

Silver nitrate: Cauterization using silver nitrate is also a commonly followed method in treating Pyogenic granulomas.

Laser surgery: Laser treatment has been gaining popularity in treating Pyogenic granulomas. It is an outpatient procedure and results in better cosmetic appearance with little or no scarring.

Excision: There are high chances of recurrence even after timely treatment in Pyogenic granuloma. In such cases, the most effective method of treatment is to completely remove affected area through surgical excision and then close it with sutures.

Dermatoses

Dermatoses are conditions affecting the skin, nails, hair or glands. Dermatoses may be acute or chronic; acute conditions last from days to weeks and chronic conditions last from months to years. Treatment for dermatoses depends on whether the condition is acute or chronic. Most dermatoses respond to treatment with topical corticosteroids.

Dermatosis types and symptoms

Acute dermatoses: Occur suddenly and symptoms include redness, itching and swelling which may further progress to blisters, oozing, scratch marks etc. But usually the symptoms subside in a few days.

Chronic dermatoses: There are small oozing blisters and crusts that may appear thickened discolored and scaly. The skin is cracked and painful.

Subacute dermatoses: Symptoms include scaliness, scratch marks, redness and may peel off. The affected areas do not ooze and do not have blisters.

Dermatosis classification

Dermatosis may be described through the following terms

Lichenification: Thickening and discoloration of skin like the lichen on a tree.

Lesion: Abnormal area of the skin.

Macule: Change in color or consistency of the skin.

Nodule: a bump in the skin that may measure larger than a centimeter in diameter.

Papule: a bump in the skin that may measure smaller than a centimeter in diameter.

Plaque: A large area of affected skin that may flake or peel, it generally has defined edges.

Pustules: A bump that is filled with pus and may have resulted due to an infection.

Rash: A variety of conditions that may show up as red raised up area from the skin and involves inflammation.

Vesicles and bullae: Raised bumps that are filled with fluid.

Various Dermatosis conditions

Acute febrile neutrophilic dermatosis (Sweet's syndrome): Sweet's syndrome is characterized by skin lesions, sore eyes, ache in joints and fever. Red, swollen rashes and papules that are tender. Neutrophilic dermatosis can be caused due to many infections such as IBD, rheumatoid arthritis or upper respiratory tract infections. Rarely it can be a sign of an underlying blood disorder or cancer.

Contagious pustular dermatosis: Also called Contagious pustular dermatitis, it can be contracted from sheep affected with sheep pox, it shows up as papules.

Digitate dermatosis: Finger shaped psoriatic rash at the side of waist.

Dermatosis cinecienta: Symmetrical patches of thickened skin that are ash colored and is generally common in individuals under 40 years.

Dermatosis neglecta: Appears like warts, is a type of plaque caused due to inadequate washing of skin in a particular area. Dermatosis neglecta surfaces in the form of localized scaling and hyperpigmentation.

Dermatosis papulosa nigra: Often seen in dark skin toned people, many small, benign, dark skin lesions are seen on the face.

Linear lichenoid dermatosis: Small and scaly papule, often seen in children.

Transient acantholytic dermatosis or Grover's disease: Chronic, itchy blistering that is usually triggered by heat or sweating. It appears suddenly as itchy red spots on the trunk. It lasts for weeks to months, but resolves spontaneously.

Juvenile plantar dermatosis: Cracking and peeling of the weight-bearing soles of the juvenile plantar dermatosis: cracking and peeling of the weight-bearing soles of the feet in children.

Rheumatoid neutrophilic dermatosis: Skin manifestation of . It manifests as reddish palms and brittle split nails. The skin on the hands might become translucent and wrinkled.

Diathermy

Diathermy is a non-invasive, therapeutic technique that uses electrical energy to produce heat deep within the body. It has been used for many years to treat various medical conditions, including pain, inflammation and muscle spasms.

Diathermy is based on the principle that electrical energy can be converted into heat when it flows through a conductive medium, such as water or tissue. The process involves the application of an alternating current (AC) to the body, which causes the tissues to resist the flow of electricity. This resistance generates heat in the affected area.

There are three primary types of diathermy:
1. Shortwave Diathermy: Also known as microwave diathermy, this type uses frequencies between 2.45 and 10 GHz to produce heat. Shortwave diathermy is commonly used for deep tissue heating.
2. Ultrasonic Diathermy: This type employs high-frequency sound waves (20-40 kHz) to produce heat through cavitation and thermal conduction. Ultrasonic diathermy is often used for superficial heating.
3. Radiofrequency Diathermy(RF Diathermy): Also known as radio wave diathermy, this type uses frequencies between 10 kHz and 100 MHz to produce heat. Radiofrequency diathermy is commonly used for deep tissue heating.

Benefits:
1. Pain Relief: Diathermy has been shown to be effective in reducing pain by increasing blood flow, relaxing muscles, and releasing endorphins.
2. Inflammation Reduction: Diathermy can help reduce inflammation by increasing blood flow and promoting the removal of waste products.
3. Muscle Relaxation: Diathermy can help relax muscle spasms and reduce muscle tension.
4. Wound Healing: Diathermy has been shown to improve wound healing by increasing blood flow, promoting collagen synthesis, and reducing bacterial growth.

Diathermy can be classified broadly into two types:
1. Continuous Wave (CW) Diathermy: This type of diathermy uses a continuous wave of energy to produce heat.
2. Pulsed Wave (PW) Diathermy: This type of diathermy uses pulses of energy to produce heat, which can be more effective than CW for deep tissue heating.

Diathermy is primarily used in the following conditions:
1. Orthopedic Conditions: Diathermy is commonly used to treat musculoskeletal conditions such as arthritis, tendonitis, and bursitis.
2. Chronic Pain Management: Diathermy is often used to manage chronic pain conditions, including fibromyalgia and complex regional pain syndrome.
3. Muscle Spasms: Diathermy can help relax muscle spasms and reduce muscle tension.
4. Post-Surgical Rehabilitation: Diathermy is sometimes used as part of post-surgical rehabilitation protocols to promote healing and reduce pain.

Contraindications:
1. Pacemakers and Implantable Cardioverter-Defibrillators (ICDs): Diathermy can interfere with the functioning of these devices.
2. Metallic Implants: Diathermy should not be used near metallic implants, as it may cause heating or sparking.
3. Cancer: Diathermy is generally contraindicated in cancer patients, as it may stimulate tumor growth.
4. Pregnancy and Breastfeeding: Diathermy is generally contraindicated during pregnancy and breastfeeding, as there is limited research on its safety in these populations.

Electrocoagulation: This minimally invasive method employs high-frequency electric currents to seal blood vessels through heat, thereby achieving hemostasis. Electrocoagulation is based on the principle that a high-frequency electric current can be used to generate heat, which in turn causes coagulation of blood vessels and surrounding tissue. This process creates a localized thermal effect that seals off blood vessels, stopping bleeding and allowing for precise surgical dissection.

Electrical Current: High-frequency electrical currents (often in the range of 0.3 to 5 MHz) are delivered through an electrode.
Heat Generation: The electrical current generates heat as it passes through tissues, leading to coagulation.
Tissue Effect: The heat causes proteins in the tissue to denature, leading to coagulation, which seals blood vessels and stops bleeding.

1. Surgical Hemostasis: Electrocoagulation is commonly used during surgical procedures to make bloodless incisions, reducing the risk of bleeding complications and enabling more accurate tissue dissection. It is especially useful in procedures involving highly vascular tissues.
Tumor Resection: Used to remove tumors while minimizing blood loss.
Polypectomy: Removal of polyps, particularly in gastrointestinal and gynecological surgeries.

2. Nosebleed Control: This technique is also effective in controlling nosebleeds, allowing for prompt and safe management of this common condition.

3. Abnormal Vessel Treatment: Electrocoagulation can be used to treat abnormal blood vessel formations, such as spider naevi, by delivering the electric current through a fine needle. This minimizes tissue damage and promotes targeted treatment.

4.Dermatology: Removal of Skin Lesions: Effective for removing warts, moles, and other benign skin lesions.
Acne Treatment: Used to reduce the size of sebaceous glands and treat severe acne.

5. Gastroenterology: Endoscopic Procedures: Used during endoscopy to treat bleeding ulcers, remove polyps, and manage gastrointestinal bleeding.
6. Gynecology: Cervical Procedures: Used in procedures such as loop electrosurgical excision procedure (LEEP) to remove abnormal cervical tissue.
7. Urology: Bladder and Prostate Surgery: Used to control bleeding during transurethral resection of the prostate (TURP) and other urological surgeries.

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