Also known as lobular capillary hemangiomas, they are common in children (especially under 3 years of age). These benign, soft, bright red, usually solitary vascular neoplasias measuring 2 mm to 2 cm often arise at the site of injury. Pyogenic granulomas tend to grow quickly and bleed easily with minor trauma. In children, 77% of lesions are localized in the face and neck.

They often develop " patch sign", i.e. contact irritant dermatitis in the form of a patch with a gauze pad, which is used to fix the bleeding papule. The average age of onset of pyogenic granuloma is approximately 6 years, with 14% of lesions developing in the first year of life and with a slight preference in boys (1.5:1). Caucasians make up 84% of patients.

Pyogenic granulomas also often appear on the mucous membranes of the cheeks and gums in 2% of pregnant women in the first 5 months of pregnancy, probably due to hormonal changes. In this case, they are called “pregnancy granulomas” or “pregnancy tumors.” Pyogenic granulomas develop over vascular defects such as port-wine stains with increased frequency, especially after pulsed dye laser therapy or during pregnancy.

The term " pyogenic granuloma"is used according to tradition, its history is connected with the fact that the infectious and granulomatous nature of the lesion was previously assumed, but it is not such. Although most clinicians continue to refer to these lesions as pyogenic granulomas, the term lobular capillary hemangioma was coined in 1980 to reflect the pathophysiology of this benign vascular tumor.

Pyogenic granuloma:
a - a hemorrhagic papule developed on the lower eyelid of an 8-year-old boy
b - another rapidly growing loose lesion between the fingers of a 5-year-old boy

Biopsy of the lesion shows a loose matrix of fibrous tissue with proliferating capillaries, similar to granulomatous tissue.

In children pyogenic granulomas most often confused with infantile hemangiomas. However, hemangiomas usually appear during the first few weeks of life, grow for 3-4 months, and then begin to regress. Fortunately, most lesions do not bleed or ulcerate. This distinguishes them from pyogenic granulomas, which are rarely seen in the first months of life and typically bleed after minor trauma.

Differential diagnosis with nonvascular solid red tumors includes spindle cell and epithelioid nevi, amelanotic melanoma, and angiolymphoid hyperplasia with eosinophilia. These tumors exhibit characteristic clinical presentations, natural history, and histologic features.

Tangential excision and cautery, a safe and effective method of removing lesions with minimal risk of scarring, takes less than a minute and is performed without sedation in most children. However, it is important to wait 5-7 minutes after infiltration of the local anesthetic to allow epinephrine to take effect and reduce the risk of bleeding at the time of tumor removal. Topical silver nitrate therapy is often associated with rapid recurrence of lesions.

Although pulsed dye laser ablation can be performed, it often requires repeat sessions several weeks apart. For large lesions (>10 cm), carbon dioxide laser or surgical excision is used.

Pyogenic granuloma Pyogenic granuloma:
a - a node with a diameter of 8 mm with a crust in the center repeatedly bled heavily before being surgically removed
b - multiple satellite lesions appeared on the back of this 10-year-old boy several months after the appearance of a single pyogenic granuloma.

Pyogenic granuloma is a benign neoplastic neoplasm of the skin and mucous membrane. This disease is not an infectious or granulomatous lesion.

The disease is also known as botryomycomoma - lobular capillary hemangioma. Pyogenic granuloma is mainly diagnosed in young people, as well as in pregnant women. Some authors report the occurrence of tumors in the gastrointestinal tract, conjunctiva and cornea.

Causes

To this day, the reasons for the development of botryomycomoma remain unclear. Experts distinguish the following risk factors:

• acute and chronic skin injuries;
• genetic predisposition;
• exposure to ultraviolet radiation;
• abrasions and disruption of the integrity of the epidermis, which is accompanied by streptococcal infection of the wound surface;
• in some cases, the formation of multiple forms occurs on the burn surfaces of patients taking contraceptives and protease inhibitors.

Symptoms

The disease causes the formation of a round neoplasm that rises above the surface of the skin. The tumor has a smooth or coarse-grained structure of the surface layers.

Pyogenic granuloma is predominantly located on the stalk. Its average size in diameter is 1.5-3 cm. The neoplasm is colored brown or red. In most cases, the disease occurs with the formation of a single focus of skin mutation, and only in a small number of patients can a multiple form of this pathology be detected.

In the initial stages, capillary hemangioma actively grows and increases in size. In later stages, a decrease in tumor size or even spontaneous regression is often observed. Such a benign neoplasm may be accompanied by bleeding, ulceration and the formation of areas of necrosis.

Photo of pyogenic granulomas on the body

Pyogenic granuloma on the face Botriomycoma of the soft palate in the area of ​​the right incisors
Pyogenic granuloma of the skin Pyogenic granuloma on a stalk, which is located on the scalp

Diagnosis of the disease

To make a diagnosis, a doctor only needs to conduct a visual examination and microbiological examination of a small area of ​​pathological tissue.

Diagnosis of the disease is carried out according to several signs.

Appearance of the pathological focus

During a visual examination, the doctor may detect the following signs of the disease:

• on the surface of the mucous membrane or skin there is a rounded node that periodically bleeds and causes a systemic decrease in hemoglobin levels;
• ulcers, erosions and crusts form in the area of ​​benign neoplasm;
• the diameter of pyogenic granuloma varies from 1 mm to 6.5 mm;
• the maximum size of a benign neoplasm reaches within a few weeks;
• the typical clinical picture of the disease (85% of clinical cases) includes a hyperemic area with a white collar along the periphery.

Localization of pyogenic granuloma

Cutaneous forms of botryomycoma are located on the head (especially the gingival surface and lips), neck, limbs and upper body.

Benign neoplasms of pregnant women are often localized in the oral cavity and on the mucous membrane of the upper jaw.

Biopsy

Establishing a final diagnosis requires histological and cytological examination of a small area of ​​mutated tissue. To do this, the doctor surgically removes a small part of the tumor and sends the biopsy to a histology laboratory.

The results of the analysis may show the following results:

1. In the early stages, the tumor consists of granulation tissue in the form of numerous capillaries, endothelium and inflammatory infiltrate.
2. Late stages of pyogenic granuloma are represented by fibromyxoid tissue, divided into separate lobules. Often, specialists identify atypical capillary proliferation. The epidermis has an erosive structure.
3. At the regression stage, extensive fibrotic processes are noted.

Differential diagnosis of the disease

Botriomycoma should be distinguished from the following malignant skin lesions: basal cell carcinoma, atypical fibromyxoma, Kaposi's sarcoma, metastases of a cancerous tumor of internal organs, squamous cell carcinoma and melanoma.

Skin cancer is characterized by the development of oncological symptoms at two levels:

1. At the systemic level, the patient notes an increase in body temperature to low-grade levels, general malaise, chronic fatigue, loss of performance, fatigue, night sweats, loss of appetite and a sharp decrease in body weight.
2. At the local level, the mutation zone ulcerates and bleeds. In some cases, a neoplasm forms at the site of a mole or age spot.

Attention! After surgical removal of a pyogenic granuloma, the removed tissue is necessarily sent to a histological laboratory to exclude the cancerous origin of the tumor.

Capillary hemangioma should be distinguished from the following benign neoplasms:

1. Cherry hemangioma - small scarlet nodes, represented by atypical proliferation of capillaries.
2. Fibrous papule in the area of ​​the nasal mucosa. The main difference between this pathology and pyogenic granuloma is the light shade of the fibrous papule (limited compaction of the epidermis).
3. Bacillary angiomatosis is a common infectious pathology caused by microorganisms of the Bartontella type. The disease occurs in four forms, one of which (spherical) is very similar to pyogenic granuloma. Bacillary angiomatosis is often accompanied by weight loss and enlargement of regional lymph nodes.

Treatment of the disease

The main treatment method for pyogenic granuloma is surgical removal of the benign tumor. This type of surgery is performed on an outpatient basis.

The patient is given local anesthesia, and the surgeon uses a scalpel to excise all pathological tissue.

Radical intervention ends with suturing the wound.

After completion of the surgical operation, all removed tissues are subjected to histological analysis. This is necessary to exclude the malignant origin of the tumor.

Some doctors testify to the effectiveness of such methods of surgical removal of tumors:

1. Cryotherapy. This treatment involves exposing the skin to ultra-low temperatures. The procedure lasts no more than 3 minutes to prevent deep hypothermia of the body. This method of eliminating mutated tissues in 50% of cases does not require local anesthesia. The advantage of cryotechnology is that the procedure is less traumatic. Ultra-low temperatures also prevent the development of bleeding before and after removal of pyogenic granuloma.
2. Laser therapy. The manipulation involves radical excision of a benign tumor using a laser beam. The procedure has a number of advantages in the form of high precision of manipulation, painless removal and absence of bleeding.
3. Electrocoagulation. The technique is based on the removal of tumor tissue through electrical currents. This treatment requires local anesthesia.

1. The best way to prevent bleeding and malignant degeneration of a benign skin tumor is radical removal of the tumor.
2. Without specific treatment, capillary hemangioma is prone to spontaneous atrophy. As a result, it slowly regresses and decreases in size. This is possible only after the action of the etiological focus has been eliminated.
3. Experts report successful treatment of recurrent pyogenic granuloma with 5% imiquimod for 14 weeks.
4. You should consult a doctor when you notice the first signs of tumor growth. This will allow timely diagnosis, differentiation from cancer pathologies and provision of comprehensive treatment.
5. Conservative treatment of botryomycoma is usually ineffective and requires only radical intervention.

Prevention and prognosis

Early diagnosis of the disease is possible with regular self-examination of the skin and regular preventive examinations by a dermatovenerologist.

It is advisable to visit a doctor once a year.

The prognosis of the disease is considered positive. Timely surgical treatment and excision of a benign tumor lead to complete recovery of the patient and the absence of tumor recurrence.

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All information is presented for educational purposes. Do not self-medicate, it is dangerous! Only a doctor can make an accurate diagnosis.

Granuloma is a focal proliferation of connective tissue cellular structures, which is a consequence of granulomatous inflammation. In appearance they resemble small nodules. They can be single or multiple. The size of the granuloma does not exceed 3 cm in diameter, the surface of the formation is flat and rough. Often, such benign neoplasms are formed when there is an infection in the body in acute or chronic form.

The mechanism of development of granuloma in humans is different and depends on the type of benign neoplasm and the reasons that caused its formation. For the granulomatous inflammatory process to begin, two conditions must exist:

• the presence in the human body of substances that give impetus to the growth of phagocytes;
• persistence of the stimulus causing cell transformation.

Sometimes a granuloma can resolve on its own, but this does not mean that if it is present, you can not contact a doctor. It is impossible to predict in advance whether the tumor will resolve on its own.

Features of involution (reverse development):

1. Granuloma annulare can resolve on its own within a few months or years. There are no scars left on the body.
2. In case of infectious lesions (syphilis), the seal resolves, leaving behind scars and cicatrices.
3. In tuberculosis, granulomatous compactions rarely resolve. This only happens if the patient’s body is actively fighting the infection.
4. does not resolve on its own.

Granuloma occurs in both adult men and women, and in children (including newborns). The disease has the following characteristics in different age groups:

1. Formations that provoke autoimmune diseases are often observed in young people.
2. In childhood, neoplasms are accompanied by a vivid clinical picture due to the imperfection of the immune system.
3. In women, granulomatous structures may appear during pregnancy.
4. Syphilitic granuloma is typical for people after 40 years of age, since tertiary syphilis manifests itself 10-15 years after the onset of the disease.
5. Tuberculous granulomas in childhood can resolve without treatment.

Causes of granuloma and stages of development

Doctors divide the main causes of granuloma into two groups - infectious (tuberculosis, syphilis, fungal infections), non-infectious:

1. Immune. They arise as a result of an autoimmune reaction of the body - excessive synthesis of phagocytes (protective absorbing cells) occurs.
2. Infectious formations arising from fungal infections of the skin, chromomycosis, blastomycosis, histoplasmosis and other infectious diseases.
3. Granulomas that appeared as a result of penetration of a foreign body - threads of postoperative sutures, parts of insects, tattoo pigment.
4. Post-traumatic nodes that appear as a result of injury.
5. Other factors (Crohn's disease, allergic reactions, diabetes, rheumatism).

Local cellular immunity is responsible for the appearance of granuloma; specialists have not yet established a more precise mechanism for the development of pathology.

Doctors distinguish the following stages of development of the disease:

• initial stage – accumulation of cells prone to phagocytosis;
• the second stage is the proliferation of accumulated phagocytic cells;
• the third stage is the transformation of phagocytes into epithelial cells;
• the final stage is the accumulation of epithelial cells and the formation of a node.

Classification

There are many types of granulomatous neoplasms and they all differ in causes, clinical manifestations and localization.

Eosinophilic granuloma is a rare disease that often affects the skeletal system, lungs, muscles, skin, and gastrointestinal tract. The reasons for the formation of this pathology are unknown. But there are several hypotheses - bone injuries, infection, allergies, helminthic infestation. Symptoms of the disease are often completely absent, and nodes are detected accidentally during examination for other reasons. If a patient, despite the absence of signs of the disease, does not reveal an increased level of eosinophils in blood tests, then diagnosis may be difficult.

Telangiectatic (pyogenic, pyococcal) granuloma. This formation has a small stalk and resembles a polyp in appearance. The structure of the tissue is loose, the color of the neoplasm is brown and dark red, and there is a tendency to bleed. Such granuloma is located on the finger, face, and in the oral cavity.

This neoplasm is similar to Kaposi's sarcoma, so it is necessary to urgently consult a doctor to avoid possible complications.

Annular (annular, circular) granuloma is a benign skin lesion, which is manifested by the formation of ring-shaped papules. The most common form of this disease is a localized tumor—small, smooth, pink nodules that form on the hands and feet.

Stewart's median granuloma (gangrenescent). Characterized by an aggressive course. Accompanied by the following symptoms:

• nosebleeds;
• nasal discharge;
• difficulty breathing through the nose;
• swelling of the nose;
• spread of the ulcerative process to other tissues of the face and throat.

Migrating granuloma (subcutaneous) grows quickly, accompanied by the appearance of erosions and ulcers on the surface. This type of neoplasm is prone to malignancy (degeneration into a cancerous tumor), so it is necessary to consult a doctor to prescribe effective treatment.

Cholesterolitis is a rare inflammation of the temporal bone, which is provoked by trauma, inflammation of the middle ear, as well as existing cholesteatoma.

Lymphatic neoplasm is accompanied by fever, cough, weight loss, itching at the site of the lesion, weakness, and soreness of enlarged lymph nodes. Over time, the disease can lead to damage to the liver, lungs, bone marrow, and nervous system.

Vascular granuloma is a series of skin growths that contain blood vessels.

An epithelioid tumor is not an independent pathology, but a type of formation in which epithelioid cellular structures predominate.

Purulent granuloma of the skin. This group includes all formations that have signs of an inflammatory process. These can be rheumatoid and infectious tumors.

Ligature (postoperative) granuloma is a compaction in the area of ​​the postoperative suture (both inside and outside). It occurs due to the ingress of tiny foreign particles onto the tissue after surgery. During the regeneration process, this area is covered with connective tissue and a pea-sized node is formed. Often such a seal resolves on its own.

Sarcoid granulomatous formation occurs in the lymph nodes and internal organs in sarcoidosis.

A syphilitic tumor occurs as a complication of syphilis if the disease is not treated for a long time.

Tuberculous (caseous) granuloma is a morphological inflammatory element, which is provoked by the penetration of microbacteria into the respiratory organs. In this case, the cellular structure of the organ, their composition and vital activity are disrupted.

Giant cell granuloma is located in bone tissue. This is a benign neoplasm that is not prone to proliferation.

Do you use folk remedies?

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Localization Features

The inflammatory focus in patients is located superficially or deeply. Granulomatous formations are classified according to their location as follows:

• nodal structures of the soft tissues of the body (skin, navel, lymph nodes);
• inguinal granuloma (vagina, penis). This form of the disease is also called venereal disease (or donovanosis);
• mucous membranes of the oral cavity (tongue, vocal cords, larynx);
• subcutaneous;
• muscular;
• vessel walls;
• compaction of the bones of the skull, jaw.

The most common localization of granulomas:

• head and face (eyelids, cheeks, ears, face, lips, nose, temples);
• sinuses;
• larynx (this form of the disease is also called contact);
• limbs (hands, nails, fingers, legs, feet);
• eyes;
• intestines;
• lungs;
• liver;
• brain;
• kidneys;
• uterus.

Let's take a closer look at the most common places where such compactions are localized.

Nail granuloma

Pyogenic granuloma is a pathology of the nail plate. It appears on any part of the nail in the presence of even a small penetrating wound. The initial stage of nail granuloma is a small red nodule that very quickly forms an epithelial collar. If the formation is located in the area of ​​the posterior nail fold, then the matrix is ​​affected (the area of ​​the epithelium of the nail bed under the root part of the nail plate, due to cell division of which the nail grows) and a longitudinal depression is formed. Sometimes nail granuloma appears due to prolonged friction or after a perforating injury. Also, similar lesions can be observed during therapy with cyclosporine, retinoids, and indinavir.

Breast granuloma

Granulosa diseases of the mammary glands include:

• lobulitis or granulomatous mastitis in chronic forms;
• knots that arise from the penetration of foreign bodies (wax or silicone);
• mycoses;
• giant cell arteritis;
• polyarteritis nodosa;
• cysticercosis.

Symptoms of granuloma in the chest in girls may not appear for a long time, but sooner or later a hematoma appears on the skin. At this moment, the woman begins to feel pain and discomfort at the site of the lesion, and when palpating the mammary gland, a tuberous lump is palpated. In this case, breast deformation occurs. As the disease progresses, the organ may lose sensitivity.

Breast lipogranuloma does not transform into cancer.

Diagnostics

It is easy to detect external skin granulomas, but it is difficult to detect neoplasms on internal organs, in the thickness of soft tissues or bones. For this, doctors use ultrasound, CT and MRI, x-rays, and biopsy.

Since granulomatous formations can be found in any organ and tissue of the body, they are diagnosed by doctors of different specialties:

• radiologist - during a preventive examination;
• surgeon - during surgery or in preparation for surgery;
• rheumatologist;
• dermatologist;
• dentist.

These same doctors can also treat the disease (with the exception of the radiologist), and, if necessary, attract specialists from other areas.

Treatment and removal methods

Treatment of granuloma is carried out using the following physiotherapeutic and surgical methods:

• phonophoresis;
• dermabrasion (mechanical, intended to eliminate superficial and deep skin problems);
• PUVA therapy;
• magnetic therapy;
• cryotherapy (exposure to the neoplasm with liquid nitrogen, due to which the affected areas of tissue are frozen);
• laser therapy (removal of granuloma using laser).

Medical treatment of granuloma consists of prescribing corticosteroids. The attending physician may also prescribe:

• Dermovate ointment;
• Hydroxychloroquine;
• Dapsone;
• Niacinamide;
• Isotretinoin;
• drugs that improve blood microcirculation;
• vitamins.

Measures must be taken to treat the underlying pathology if it is possible to accurately diagnose it.

Not all granulomatous formations require immediate removal surgery. Some tumors cannot be removed at all, especially if they are caused by infectious or autoimmune processes. Superficial nodes are removed with a scalpel under local anesthesia. The method of surgical intervention is chosen by the attending physician based on the signs of the disease, diagnostic data and patient complaints.

Folk remedies and methods of treating granuloma must be agreed with a doctor. This is due to the fact that some plants contain substances that can cause active growth of the node and its malignancy (degeneration into a cancerous tumor).

The most common folk remedies:

1. Mix tincture (30%) of celandine with pharmaceutical glycerin. Apply compresses at night.
2. In a ratio of 1:5, take elecampane roots and dry rose hips. Pour boiling water, steep and take as tea.
3. Take a tablespoon of lemon juice and honey, add 200 ml of radish and carrot juice. Take a tablespoon before meals.

Only a specialist should treat granulomas. Self-treatment and removal of nodes can lead to consequences such as infection, heavy bleeding, sepsis, sclerosis and tissue necrosis.

This article will discuss a disease with which patients can often seek outpatient appointments with a surgeon or dermatologist. Or, scared, they run to the oncologist.

Pyogenic granuloma

This is a fairly common benign vascular tumor that can occur equally often in children and the elderly. It is a capillary proliferation that can mimic other vascular diseases, vascular tumors, or soft tissue infections. Obviously, self-diagnosis is not worth doing.

A disease without a cause or name

The reasons for the formation have not been precisely established. Another name for pyogenic granuloma is botryomycoma. This name is rather historical: a fungus of the genus Botriomices was assumed to be the causative agent. Therefore, “botryomycoma” is an incorrect name. As well as " pyogenic granuloma“... This term was introduced back in 1904 and, according to modern data, also does not reflect the nature of the disease. Yes, the granuloma can become contaminated with microorganisms, but they are not of great importance in the pathogenesis (“pyogenes” means “purulent” in Latin). In foreign literature, you can often find the term lobular (or lobular) capillary hemangioma.

The main cause of pyogenic granuloma is now considered to be minor trauma or trauma, mutations of the BRAF gene. Well, charges have also been brought against herpes virus type 1, the OrfV virus (poxvirus family) and papillomavirus type 2.

Scientists attribute an increase in progesterone levels to the reasons for the appearance of pyogenic granulomas in pregnant women (most often in the oral cavity). According to other authors, the likelihood of these vascular tumors occurring in men and women is the same. In general, it is clear that the matter is dark.

In fact, there are a number of reasons that lead to focal proliferation (growth) of small vessels - angiogenesis.

For the most part, pyogenic granuloma is a single formation. But multiple granulomas are something that oncologists may encounter as a complication of drug therapy. For example, the drugs vemurafenib and encorafenib. They selectively inhibit the BRAF protein. During such chemotherapy, there may be several granulomas.

BRAF is a gene that encodes a protein of the same name. Normally, this protein is inactive, but is activated under certain circumstances and stimulates cell growth (for example, in a wound there is a need for cell growth, in particular granulation tissue). When a mutation occurs, the gene does not respond to the signal and the cells divide on their own. Simply put, the switch does not work. This is one of the mechanisms for the development of malignant tumors (for example, BRAF-positive melanoma).

In surgical practice, pyogenic granulomas are encountered quite often. Still, most patients note some kind of traumatic factor. For example, I pricked my finger or tore off a hangnail from my nail. Or rubbed a callus, like this patient’s.

Removal of pyogenic granuloma

It is the most optimal treatment method. It is preferable to use a laser or radio wave scalpel. Histological examination of the removed material is mandatory.
Unfortunately, about 15% of pyogenic granulomas recur after removal. Relapse is especially common in pregnant women.

Another case. This was already photographed by the patient himself. After a nail injury, a large subungual hematoma occurred. He contacted me a week after the injury. Most of the nail plate was peeled off, so it was surgically removed. A few days later, a pyogenic granuloma formed. Removed during a follow-up appointment with a radio wave scalpel. Everything ended well.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What are the types and types of granulomas?

Single clear classification granulomas does not exist, since this is a very common type of tissue damage that occurs in a variety of pathologies. In most cases, granulomas are distinguished by the reasons that caused their appearance. For example, all tuberculous granulomas have a similar structure and cellular composition. At the same time, tuberculous granuloma is very different in structure from, for example, syphilitic gumma or granuloma in sarcoidosis.

You can also divide granulomas into types and types according to the following criteria:

• Mechanism of education. Accordingly, we can talk about infectious and non-infectious granulomas. Infectious diseases are sometimes divided into fungal and bacterial depending on the type of pathogen.

• Location in the body. Granulomas of internal organs, skin, bones and other tissues are distinguished. Also, according to this criterion, we can talk about superficial or deep granulomas. The former are visible to the naked eye or palpable, while the latter are detected only with the help of special diagnostic methods ( Ultrasound, radiography, etc.).
• Quantity. According to this criterion, granulomas can be divided into single ( solitary) and multiple.

All these criteria are usually used when describing the lesion itself or to clarify the diagnosis. They usually do not have wide practical application. For treatment it is important to know exactly the cause ( pathology), which caused the appearance of granuloma.

It should also be noted that some granulomas can be an independent disease ( annular, inguinal, etc.). Others represent only one of the manifestations of systemic pathologies or infections ( tuberculosis, sarcoid, etc.). Next, we will look at the different types and types of granulomas that patients may encounter when formulating a diagnosis.

Specific and nonspecific granulomas

All granulomas can be divided into specific and nonspecific. Nonspecific granulomas have an identical structure ( zones) and cellular composition. As a rule, they arise due to the fact that certain substances or components that have entered the tissue cannot be absorbed or released naturally. The body, isolating such areas of inflammation, forms granulomas in the tissues.

Specific granulomas have approximately the same mechanism of formation, but differ in the structure of the lesion or clinical course ( symptoms and manifestations). Most often, specific granulomas occur against the background of various infections. For example, granulomas in the lungs in tuberculosis are distinguished by caseous necrosis ( destruction of tissue in the center of the granuloma with the formation of a cheesy substance). With syphilis, granulomas also have differences in structure. This is why they are called specific.

From a practical point of view, it does not matter much whether the granuloma is specific or nonspecific. In any case, to begin treatment, it is necessary to establish the specific cause of its occurrence and only then begin treatment. Treatment may vary greatly ( that is, nonspecific granulomas in different patients may require different treatment). Since specific granulomas are usually caused by infections, antibacterial drugs are usually needed to treat them.

Pathological granuloma

Granulomas themselves are one of the manifestations of an acute or chronic inflammatory process. Inflammation is a pathological phenomenon, as it is a universal reaction to various damage to cells and tissues. Thus, all granulomas are pathological.

The word “pathological” itself implies the result of some kind of disease. Its antonym is the word “physiological,” that is, characteristic of a healthy organism. A granuloma cannot be physiological, because such formations are absent in a healthy body.

Granuloma annulare ( annular, circular)

Granuloma annulare is a separate dermatological disease, the causes of which have not been fully established. There are several types of this pathology, but in general it can appear at almost any age. The disease is a granulomatous inflammation of the skin. In most cases, it does not cause serious inconvenience to the patient and can go away on its own. A connection has been established between the appearance of granuloma annulare and a number of hormonal ( thyroiditis) and immune disorders in the body. It is also believed that granuloma annulare may be a consequence of trauma. The average duration of the disease ranges from several months to several years.

There are the following types of granuloma annulare:

• Localized granuloma. This form is characterized by the appearance of small nodules ( papules) in the shape of a ring or semicircle. More often it appears on the limbs ( dorsum of hands, feet, forearms) and initially has a diameter of several millimeters. Gradually, the granuloma can increase and the diameter of the “ring” reaches 5 cm. The skin in the affected area may be normal or slightly bluish, and there are usually no other complaints.
• Papular granuloma. Characterized by disorganized ( not necessarily in the shape of a ring) spread of papular rash. The elements of the rash do not merge and remain isolated from each other until the end of the disease.
• Deep ( subcutaneous) granuloma. With this form, the elements of the rash are located deep in the skin and are usually not visible to the naked eye. The nodules can be easily palpated. They can be mobile ( mobile to the touch) on the limbs and almost always fixed on the scalp. This form of granuloma annulare affects mainly children under 5 years of age.
• Disseminated granuloma. This form, on the contrary, occurs mainly in patients over 50 years of age. With it, the patient has characteristic lesions in various parts of the body.
• Perforating granuloma. With this form of the disease, the elements of the rash seem to burst, releasing a jelly-like substance ( sticky, yellowish). It is believed that an ordinary localized granuloma due to trauma can become perforating ( scratching, burning, etc.). On the elements of the rash, when they do not produce discharge, there are small nodules ( visible under a magnifying glass or upon close inspection).

Granuloma annulare usually does not leave scars or scars, but the perforating form may leave small scars after healing. In general, the disease is not dangerous, but requires careful diagnosis. If characteristic rashes appear, patients are advised to consult a dermatologist and undergo basic tests ( blood test, urine test, etc.). Other skin diseases with similar manifestations should be excluded - fungal infection, small nodular sarcoidosis, lichen planus, etc.

Stewart's median granuloma ( gangrenescent)

This granuloma occurs on the nasal septum inside the nasal cavity. The reason for its appearance has not yet been fully clarified. Some experts classify it as a type or one of the stages of Wegener's granulomatosis. Usually the disease progresses quite quickly.

The most characteristic signs of a median granuloma ( at different stages) are:

• nasal discharge;
• periodic nosebleeds;
• difficulty in nasal breathing;
• purulent discharge;
• swelling of the nose;
• spread of the ulcerative process to nearby tissues ( face, throat, laryngeal, etc.).

Progressive tissue destruction in this disease has a poor prognosis. In most cases, doctors fail to stop the process, and the patient dies from complications within several years. The immediate cause of death is sepsis, which develops due to the presence of a purulent focus.

Multiple granulomas

Multiple granulomas can occur in a number of different pathologies of an infectious or autoimmune nature. As a rule, the simultaneous appearance of several formations indicates a systemic disease. In this case, granulomas are not the main pathology, but only its manifestations. In most cases, several granulomas appear in the same tissue. This is explained by the fact that in each individual case the disease “attacks” certain cells. For example, tuberculosis most often affects the lungs, and several granulomas can be found in them. In sarcoidosis, multiple granulomas are most characteristic in the area of ​​the roots of the lungs, and in granuloma annulare, the formations are located on the skin ( rarely under the skin).

But it is also possible to damage several types of tissue at the same time. More often this occurs with a systemic infection, when pathogens spread throughout the body through the bloodstream.

The following diseases can cause the simultaneous appearance of granulomas in different tissues:

• histiocytosis;
• extrapulmonary ( systemic) tuberculosis;
• syphilis;

It should be noted that multiple granulomas on the body or in internal organs are usually regarded as a contraindication to a surgical solution to the problem. The very fact of damage to various tissues indicates the systemic nature of the disease. Most of these granulomas disappear ( not always without a trace) when prescribing effective antibiotics or other medications ( depending on the underlying disease).

Granuloma migrans ( subcutaneous)

Migratory granuloma is one of the complications of dental granuloma. In this case, the primary focus is usually located at the root of the tooth. Once an infection occurs, it can break into the subcutaneous tissue, where it causes inflammation. As a result, a small compaction may form ( sometimes soft to the touch), which is a migratory subcutaneous granuloma. Pus does not form in this place, but there may be accumulations of intercellular fluid. The formation can be localized in one place or gradually spread, forming other foci. In this case, the initially formed subcutaneous lesion may gradually disappear, which gives the impression that the granuloma is “migrating”.

Most often teenagers and adults get sick. The main cause of the disease is the spread of infection from the primary focus at the root of the tooth. Granuloma may disappear on its own within a few months or, rarely, years. Treatment involves eliminating the dental granuloma and prescribing antibiotics. The disease does not pose a serious danger to the patient. The formation is usually painless and is more of a cosmetic defect, as it is localized on the face. Along the way, damage to the jaw bone or lymph nodes may occur. Then the symptoms will be different and there is a risk of other complications.

Pyogenic granuloma

This granuloma is considered an independent disease and is one of the benign neoplasms. Most often it is localized on the skin or mucous membrane ( usually the mouth or lip). Teenagers often suffer from pyogenic granuloma, and it is also very common in women during pregnancy. Presumably, some skin problems and superficial injuries may be related to the development of the disease ( burns, etc.) and infections. The causes and mechanism of development of this pathology have not been definitively established. It is noted that the risk of such granuloma increases with the use of contraceptives ( contraceptives).

Pyogenic granuloma is a superficially located formation with a diameter of several millimeters to several centimeters. The color is usually red due to the large number of small blood vessels. Periodic bleeding is possible, but there is usually no pain.

Pyogenic granulomas have the following features:

• rapid growth in education;
• the appearance of ulcers or erosions on the surface;
• can go away on its own ( growth slows down, the lesion “dries out”);
• after disappearing it leaves a small scar or scar.

It is imperative to consult a specialist when this formation appears in order to exclude malignant skin tumors. Surgical removal of the granuloma is recommended ( possible with laser or cryosurgery). Relapses ( repeated manifestations) are rare. There is no threat to the baby during pregnancy. Once the diagnosis is confirmed, removal of the granuloma is usually postponed and done after childbirth.

Eosinophilic granuloma

Eosinophilic granuloma is one of the variants of the clinical course of such a serious disease as histiocytosis. The definitive causes of this pathology are still unknown. It has been established that the disease is manifested by tissue proliferation, which can occur in various organs and tissues ( often in the spleen, lungs, lymph nodes). Apparently, immunocompetent cells take part in this process ( Langerhans).

In principle, histiocytosis can have three main clinical courses:

• Eosinophilic granuloma. The pathological process most often affects parenchymal organs ( liver, spleen, kidneys, etc.), as well as bones. Education can be single or multiple. Especially often, numerous small granulomas are found in the bones.
• Letterer-Siwe disease. This form of histiocytosis occurs in young children. According to statistics, children aged about 2 years are most often affected. Multiple lesions appear in the bones and various organs. Significant enlargement of the liver and spleen is often observed. Lymph nodes are also usually enlarged and may merge. When visualized using magnetic resonance imaging, the structure of the organ can be greatly changed.
• Hand-Schueller-Christian disease. This form occurs more often in boys aged 10–12 years. Most often, this disease is understood as a set of complications and consequences of the progression of eosinophilic granuloma. Large formations are detected in the bones, lymph nodes, liver, and lungs. The lesions acquire a yellowish tint due to the gradual accumulation of fat cells. When the bones of the skull are affected, a wide range of different disorders are possible. The most typical exophthalmos ( goggle-eyed) and hormonal disorders ( diabetes insipidus, hypogonadism, etc.), associated with compression of the pituitary gland.

In general, with eosinophilic granuloma, the patient may complain of a variety of disorders. This is mainly due to the location of the lesions, their number and size. The disease is difficult to diagnose, and treatment is not always effective.

Giant cell reparative granuloma

This type of granuloma is located in bone tissue. The exact mechanism of development of this disease and the reasons for its occurrence are unknown. The formation is a variant of a benign tumor, which, however, does not grow. The disease is localized in one specific place. The bones of the fingers are most often affected, but the bones of the skull and jaw can also be affected. Much less often, giant cell granuloma forms in long bones ( femoral, shoulder, etc.).

With this disease, as a rule, one bone is affected. Sometimes, with a congenital predisposition, children may have symmetrical damage to paired bones ( for example, on both sides of the jaw). A focus of cells atypical for bone tissue is formed in the bone. The disease progresses slowly, and the main manifestations are local pain ( especially when pressed) and swelling of the tissues around the bone. In most cases, surgical treatment is recommended. After eliminating the problem, a relapse is possible ( reappearance).

Lymphatic granuloma

Lymphatic granuloma is sometimes called Hodgkin's disease ( lymphogranulomatosis). This is a malignant lesion of lymphoid tissue ( usually lymph nodes and spleen), in which not only granulomas appear, but there are also other symptoms. The disease occurs almost one and a half times more often in men. Among the possible causes of this pathology, some infections are considered ( Epstein-Barr virus) and the impact of various external and internal factors. In general, the causes of lymphogranulomatosis are still poorly understood.

The disease most often occurs between the ages of 20 and 30 and, less commonly, after 55. Lymphogranulomatosis begins with enlargement of the lymph nodes located on the neck and near the collarbones. Other groups are also less commonly affected ( inguinal, abdominal, etc.). Enlarged lymph nodes do not hurt and are mobile when palpated.

Patients with lymphatic granuloma may experience the following symptoms:

• moderate increase in temperature;
• cough and difficulty breathing ( due to enlarged lymph nodes in the mediastinum);
• gradual weight loss is possible;
• general weakness;
• enlarged spleen;
• increased sweating ( especially at night);
• pain in enlarged lymph nodes ( appears often after drinking alcohol).

Symptoms may not exist for a long time. Lymph nodes may also gradually decrease to normal size and then increase again. Over time, the disease leads to damage to internal organs - the liver, nervous system, lungs, bone marrow. Accordingly, patients may experience symptoms from the affected organ.

The main danger lies in the numerous complications of this disease. Granulomas compress neighboring tissues and can lead to a variety of disorders ( for example, anemia due to bone marrow damage). Immunity is also greatly weakened, causing the patient to suffer from secondary infections. In general, the prognosis is unfavorable. With intensive treatment, it is possible to extend the life of patients by an average of 4–5 years.

Vascular granuloma

In principle, there is no separate disease with this name. Most often, the term “vascular granuloma” combines a number of skin formations that are rich in blood vessels. This is sometimes called hemangiomas and other tumors that occur ( grow up) from vascular tissues. This category includes, for example, pyogenic granuloma.

Epithelioid granuloma

Epithelioid granuloma is not an independent disease. This is one of the types of histological classification of formations, which indicates that epithelioid cells are present or predominate in the granuloma. Such granulomas do not have a clear dependence on certain pathologies. Epithelioid cells may predominate at one stage of the disease ( tuberculosis, other infectious diseases). For the patient, the term “epithelioid granuloma” does not convey any information. It is sometimes used when making a diagnosis if a histological examination of tissue has been carried out.

Cholesterol granuloma

This granuloma is a very rare tumor-like lesion of the temporal bone that can affect the hearing system. Symptoms are usually associated with hearing impairment, concomitant inflammation in the tissues, and pain. The pain may intensify when pressure is applied to the temporal bone around the ear ( depending on the location of the granuloma).

It is assumed that granuloma forms after illness or injury ( including barotrauma caused by a sudden drop in pressure). A focus is formed in which cholesterol compounds are deposited. Gradually it turns into granuloma. In most cases, a surgical solution to the problem is recommended. The disease can cause very unpleasant symptoms, but usually does not pose a serious threat to life.

Inflammatory granuloma

Inflammatory granuloma, as a rule, is called such formations that have all the signs of an acute inflammatory process. It should be noted that granulomas, having, in principle, an inflammatory nature, do not always have a pronounced clinical picture ( symptoms, complaints). When we talk about inflammatory granuloma, complications are often implied.

The following formations can be classified as inflammatory granulomas:

• rheumatic granulomas;
• inflammation of tooth granuloma;
• some infectious granulomas.

However, even the infectious process does not always occur with pronounced signs of inflammation ( redness, pain, swelling, etc.). For example, with tuberculosis, granulomas can form in the lungs without causing pronounced symptoms ( so-called “cold” inflammation).

Thus, the term “inflammatory granuloma” can be used to combine a number of different formations that are characterized by a pronounced inflammatory process. However, the nature of inflammation, diagnosis and treatment can vary greatly.

Telangiectatic ( pyogenic, pyococcal) granuloma

This disease is a variant of hemangioma ( neoplasms arising from blood vessels). This granuloma most often forms at the site of injury, and therefore can be considered one of the variants of post-traumatic granuloma. Tissue destruction during injury is often accompanied by infection ( pyococci). Sometimes this results in a small tumor ( 0.5 – 2 cm in diameter), which is a telangiectatic granuloma.

The main signs of this disease are:

• formation of a dark red or brown color;
• loose fabric structure;
• bleeding ( spontaneous or with minor trauma);
• rapid increase in size.

The granuloma may have a small “leg”, resembling a polyp. It is most often located on the fingers, in the nail bed, on the face, less often in the mouth or other parts of the body. It is recommended to immediately consult a doctor, since the formation is similar to another dangerous pathology - Kaposi's sarcoma. Surgical removal of the granuloma is usually necessary ( usually laser surgery). The prognosis is favorable, and if you consult a doctor in a timely manner, there is no threat to health or life.

Chronic granuloma

In principle, in medicine there is no clear division of granulomas into acute and chronic, since this is not an independent disease, but only one of the manifestations of another pathology. In some cases, granulomas appear in the acute phase. An example of such a pathology is syphilis. In the chronic course of the disease ( usually years or decades after infection) granulomas may appear during exacerbations. Exacerbations are caused by a temporary weakening of the immune system. However, even in this case it is incorrect to talk about “acute granuloma”. It would be more correct to say “exacerbation of syphilis,” which manifests itself, among other things, as granulomas.

Patients sometimes call chronic granulomas those formations that do not disappear over time. Often these are simply accumulations of connective tissue ( scars, cicatrices), and not granulomas in the full sense of the word. However, with some pathologies, formations may not disappear for a very long time.

“Chronic” granulomas are possible with the following pathologies:

• Tuberculosis. After recovery, the lesion in the lungs may become calcified. It will no longer be dangerous, since the infection is reliably isolated. However, on an x-ray, for example, such a calcified granuloma, which in this case is called a “Ghon lesion,” will be visible throughout your life.
• Post-traumatic granulomas. After injury, a granuloma can form during the tissue healing process. Then it is simply an accumulation of connective tissue fibers in the form of a nodule. Sometimes a granuloma contains a foreign body that the body could not destroy or excrete. In these cases, granulomas may not dissolve throughout life, but they can be removed surgically.
• Dental granuloma. Granulomas in the pulp or at the root of the tooth may not bother the patient for a very long time. In fact, they are chronic. “Exacerbation” often occurs due to infection or during the growth of the body ( if the granuloma is congenital or formed in childhood).

Simple granuloma

In principle, in medicine there is no division of granulomas into “simple” and “complex”. More often, a “simple” granuloma means a formation that does not give any symptoms, that is, in principle, does not bother the patient. In dentistry, a “simple” granuloma is sometimes called a formation with a typical cellular composition, but this is also very arbitrary. We can call dental granulomas simple, which sometimes do not appear for many years. It is also logical to call uncomplicated granulomas in various pathologies simple. However, when formulating a full diagnosis, such a definition is still not used.

Localization of granulomas

Inflammation is a universal defense mechanism of the body, so it can develop in almost any tissue of the body. Granulomas, being one of the possible variants of the inflammatory process, can also have different localizations. Infectious granulomas are most often located in tissues that have come into direct contact with the pathogen. For example, the causes of pulmonary granulomas are very diverse. The infection enters here with inhaled air. Infectious bone granulomas are much less common, since there is not such intense blood flow here, and it is literally more difficult for infections to get here.

If we talk about autoimmune processes that cause the appearance of granulomas, then each pathology is characterized by damage to one or another tissue. This is explained by the presence of specific autoantibodies and antigens, which are played by certain cells ( or cell components) own body. For example, with sarcoidosis the lungs and lymph nodes at the roots of the lungs are most often affected, with histiocytosis - the liver, spleen, lungs and bones.

In general, we can say that granulomas can be located in almost any organ or tissue of the body. Moreover, the same cause can cause the appearance of granulomas in different places. That is why the localization of this formation in no way predetermines the treatment tactics. For example, all finger granulomas cannot be treated by removing them, and all liver granulomas cannot be treated with antibiotics. Next, various options for the localization of granulomas will be listed with a list of possible reasons for their appearance.

Granuloma on the head ( eyelids, cheeks, ear, face, lips, nose, maxillary sinus)

In many pathologies, granulomas form on the face. There are several prerequisites for this. Firstly, there are various organs and tissues on the face that can be affected by the corresponding disease. Secondly, the soft tissues of the face have a good blood supply. Thirdly, many pathologies are associated with dental granulomas, which are very common.

In general, the following organs and tissues on the head are most often affected by granulomas:

• nose, nasal cartilage and epithelium of the nasal passages ( Wegener's granulomatosis, median granuloma, syphilis, etc.);
• skin and subcutaneous layer ( granuloma migrans, pyogenic granuloma);
• mucous membranes of the lips;
• ears ( complication of cholesterol granuloma);
• sinuses ( Wegener's granulomatosis).

Also, lymph nodes behind the ears may become enlarged in the case of lymphogranulomatosis. Sometimes patients call granulomas the scarred areas of skin that form during purulent acne. If any granuloma appears on the face, you should immediately consult a doctor, since many diseases that cause such formations pose a serious threat to life.

Bone granuloma ( skulls, jaws)

Bone granulomas are much less common than soft tissue granulomas. They may be the result of injury or abnormal development of bone tissue ( usually with congenital disorders). Autoimmune processes and infections rarely cause the appearance of such formations, since this requires the penetration of the damaging agent into the bone through the bloodstream. In autoimmune processes, antibodies against the body’s own cells act as such an agent, and in infections, pathogenic microorganisms act.

Bone granulomas can be caused by the following pathologies:

• cholesterol granuloma ( usually in the temporal bone);
• eosinophilic granuloma ( histiocytosis);
• syphilis;
• tuberculosis ( for example, spinal tuberculosis).

The formation of granulomas in the jaw, in principle, can be equated to a variant of dental granuloma. Apical granulomas are located at the apex of the root, that is, almost at the border of the tooth and jaw. In most cases, bone granulomas have scant symptoms. Pain may appear when pressing on the area of ​​the granuloma or when putting stress on the bone ( for example, when chewing in the case of granuloma of the jaw). Such formations progress slowly and are difficult to detect at an early stage. The best diagnostic method is radiography, since the bone density in the area of ​​the granuloma is usually lower.

Granuloma of the arm and leg ( hand, nail, finger, foot)

In most cases, such granulomas are the result of infectious processes. Granulomas are localized mainly in the thickness of soft tissues, less often affecting the bones of the extremities. Small compactions and inflammatory foci that are the result of household injuries are often mistaken for superficial granulomas ( cuts, burns, etc.).

There are a number of infections that, in principle, can affect almost any organs and tissues. These include, first of all, syphilis and tuberculosis. When the immune system is weakened and pathogens are widespread in the blood, granulomas can appear in any organ.

Granuloma of the brain most often refers to formations not in the brain substance itself, but on the membranes of the organ. For example, Durk's granuloma is a specific lesion of the dura mater in malarial meningitis. In newborns, brain granulomas are often associated with congenital listeriosis, which they become infected with in the prenatal period.

When granulomas form in the brain and its membranes, the following symptoms are most often observed:

• coordination problems;
• visual and hearing impairment;
• heat;
• sensitivity disorders;

People with tuberculosis who have a weakened immune system may develop tuberculous meningitis, which is difficult to treat. With advanced syphilis, damage to the central nervous system is also possible. This form of the disease is called neurosyphilis.

Pulmonary granulomas are most often caused by various infections, but can sometimes be a consequence of sarcoidosis. The location of granulomas in the lungs, as well as their size, depend on the diseases that caused their appearance. In most cases, pulmonary granulomas, regardless of their origin, are diagnosed by X-ray examination. After detecting a pathological focus, additional studies are carried out to make a final diagnosis.

Granulomas in the lungs can be caused by the following diseases:

• Sarcoidosis. Sarcoid granulomas can affect both the lung tissue and the lymph nodes located at the roots of the lungs. The main danger is the gradual compression of the airways and the development of respiratory failure.
• Histiocytosis. In histiocytosis, granulomas are usually multiple. They can appear not only in the lungs, but also in many other organs.
• Tuberculosis. In tuberculosis, granulomas have a specific name - Ghon's lesion - and are most often localized in the upper lobes of the lungs. The main symptom is a persistent cough ( weeks, months), which practically does not respond to treatment. In the center of the Gon lesion, tissue softening is observed with the formation of cheesy masses ( caseous necrosis).
• Fungal diseases. Granulomas in the lungs can form when a fungal infection enters the respiratory tract. This is most often observed in people with weakened immune systems. The most pathogenic granulomatous fungal infections are histoplasmosis, coccidioidosis, and paracoccidioidosis. They are rare, but can affect even people with normal immunity. Fungal infections such as candidiasis, cryptococcosis, pneumocystosis usually occur with weakened immunity ( against the background of blood diseases, human immunodeficiency virus, long-term use of antibiotics). Granulomas in fungal infections are usually multiple. Symptoms are varied and may resemble pneumonia, bronchitis, tuberculosis or be asymptomatic.

In the kidneys, granulomas can appear due to autoimmune processes. This is explained by the fact that antibodies circulating in the blood are often retained in the filtration apparatus of the kidney. The result is an inflammatory process that can lead to the formation of granulomas.

Often, after recovery and elimination of the granuloma itself in any organ, the patient may experience residual effects. They are caused by irreversible damage to a specific area of ​​the organ. After sarcoidosis or tuberculosis, respiratory failure is possible, after intestinal granulomas - problems with stool or even signs of intestinal obstruction.

Granuloma of the soft tissues of the body ( skin, navel, lymph nodes, breast, anus)

Granulomas of soft tissues and skin are the most common localization. There are many reasons that can lead to their appearance. First of all, the skin contains a large number of cells responsible for the local destruction of infection and foreign microorganisms. It is these cells that form granulomas under certain conditions.

Umbilical granuloma in newborns can form due to trauma that accompanies cutting the umbilical cord. This complication does not occur often and usually does not pose a serious threat to the life and health of the child.

Granulomas of the larynx and the vocal cords located in it have very unique symptoms. Patients often experience changes in voice timbre, discomfort during conversation and sore throat. The vocal cords are affected by trauma or some rheumatic diseases. An ENT doctor treats granulomas in the throat ( otorhinolaryngologist).

Piercing granuloma

A piercing of the nostril, septum, or ear is medically considered an injury that can theoretically lead to the formation of a granuloma. Most often, the cause is incorrect technique for performing the procedure, as well as non-compliance with hygiene standards during or after the procedure. Trauma to the mucous membrane or skin leads to the formation of a small lump, which is usually a purely cosmetic problem. Removal of such granulomas requires simple surgery.

Much more often, purulent complications that develop when an infection occurs during a puncture are mistaken for a granuloma. In these cases, the lesion is inflamed and hurts at rest and when touched. The skin over the abscess is stretched and shines in the light. Such a compaction is not a granuloma. It requires surgical treatment of the lesion, and otherwise it can lead to the spread of the infectious process and various complications.

Symptoms and signs of granuloma

Since most granulomas are not an independent disease, it is not entirely correct to talk about any symptoms and manifestations of these formations. Symptoms may appear in parallel with the granuloma and are usually manifestations of the underlying disease. They are varied and depend on what kind of pathology we are talking about.

The symptoms and signs of granuloma itself depend on many factors. Among them, the determining factor is the location of education. For example, a dental granuloma will present differently than a liver granuloma. An important factor is also the presence of various complications. The table below shows the location of granulomas and possible symptoms.

Symptoms and manifestations of granulomas of various organs and tissues

Affected organ or tissue	Example of pathology	Symptoms and signs
Cutaneous and subcutaneous granulomas	Granuloma annulare.	May be missing. Redness, itching, swelling, palpable lump under the skin. Peeling of the skin is possible.
Liver	Sarcoidosis, granulomatous infections, histiocytosis.	May be missing. Possible dull pain in the right hypochondrium, less often – jaundice, discoloration of stool.
Lungs	Sarcoidosis, tuberculosis, histiocytosis.
Complications of various granulomas	Inflammation, infection or injury to a superficial granuloma.	The appearance or intensification of pain, the formation of an ulcer at the site of the granuloma, leakage of fluid or pus.

Is there fever with granuloma?

The granuloma itself, in the absence of complications, does not cause an increase in temperature. Body temperature rises due to the release and entry into the blood of special substances - pyrogens. They are not formed in all diseases. Most often, fever is a consequence of an active inflammatory process or infection. Thus, some diseases that cause granulomas can also cause an increase in temperature.

Pathologies such as tuberculosis and syphilis usually do not cause a strong increase in temperature. They are characterized by a slow increase in symptoms and periodic exacerbations. The temperature can sometimes reach 37 – 37.5 degrees and rarely rises above. Fever is also not typical for autoimmune processes ( sarcoidosis, rheumatoid arthritis, etc.).

The main reason for the strong increase in temperature ( 38 degrees and above) are usually infectious and purulent complications. For example, inflammation of a dental granuloma can cause the formation of pus.

Pain at the site of granuloma

Most granulomas, in the absence of an acute inflammatory process at the site, do not cause severe pain. For example, with granuloma annulare located on the skin, neither touching nor pressing usually causes acute pain. Granulomas in the lungs also most often do not cause pain, since the lung tissue is devoid of sensitive nerve endings. With tertiary syphilis, slow tissue destruction occurs in the area of ​​granulomas, but this is also not always accompanied by pain.

Pain can sometimes appear with granulomas in the liver ( in the right hypochondrium), on the meningeal membrane of the brain ( headache), with dental granuloma. Most often, pain occurs when the granuloma is inflamed or infected with opportunistic microflora. In other words, pain occurs due to compression of nearby tissues, swelling, and damage to nerve endings during the formation of pus.

Sometimes formations that resemble painful granulomas represent developing malignant tumors. If any granulomas appear or are detected ( painful or painless) it is necessary to consult a specialist to make a correct diagnosis.

Before use, you should consult a specialist.