Isotretinoin induced nail fold pyogenic granuloma resolution with combination therapy: A case report and review of the literature

Main Article Content

Jonathan Bellew
Chad Taylor
Jaldeep Daulat
Vernon Mackey


Isotretinoin, Nodulocystic acne, Pyogenic granulomas


Pyogenic granulomas are vascular hyperplasias presenting as red papules, polyps, or nodules on the gingiva, fingers, lips, face and tongue of children and young adults.  Most commonly they are associated with trauma, but systemic retinoids have rarely been implicated as a causative factor in their appearance.  We present a case of spontaneous eruption of multiple pyogenic granulomas of the bilateral periungal fingers in an otherwise healthy adolescent male undergoing isotretinoin therapy for severe nodulocystic acne. These pyogenic granulomas did not resolve spontaneously with discontinuation of isotretinoin, or first line therapeutic modalities. Their resolution did occur with administration of intralesional steroids and ablation with silver nitrate.


1. Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. Third Edition. Vol 2. Elsevier Saunders; 2012;1922-1923.

2. Kerr DA. Granuloma pyogenicum. Oral Surg Oral Med Oral Pathol. 1951;4:158.

3. Campbell JP, Grekin RC, Ellis CN, et al. Retinoid therapy is associated with excess granulation tissue responses. J Am Acad Dermatol. 1983;9:708-713.

4. Exner JH, Dahod S, Pochi PE. Pyogenic-like acne lesions during isotretinoin therapy. Arch Dermatol. 1983;119:808-811.

5. Piraccini BM, Bellavista S, Misciali C, Torti A, de Berker D, Richert B. Periungal and subungal pyogenic granuloma. Br J Dermatol. 2010;163:941-953.

6. Shalita AR, Cunningham WJ, Leyden JJ, et al. Isotretinoin treatment of acne and related disorders: An update. J Am Acad Dermatol. 1983;4:629-638.

7. Figueiras DA, Ramos TB, Marinho AK, Bezerra MS, Cauas RC. Paronychia and granulation tissue formation during treatment with isotretinoin. An Bras Dermatol. 2016;91(2):223-225.

8. Miller RA, Ross JB, Martin J. Multiple granulation tissue lesions occurring in isotretinoin treatment of acne vulgaris – successful response to topical corticosteroid therapy. J Am Acad Dermatol. 1985;12:888-889.

9. Tay YK, Weston WL, Morelli JG. Treatment of pyogenic granulomas in children with the flashlamp-pumped pulsed dye laser. Pediatrics. 1997;99:368-370.

10. Matsumoto K, Nakanishi H, Seike T, et al. Treatment of pyogenic granuloma with a sclerosing agent. Dermatol Surg. 2001;27:521-523.