Pyogenic granuloma (PG) is a benign vascular lesion commonly found in the skin and mucous membranes, often presenting challenges due to its tendency to bleed and recur[1]. Traditional treatments for PG include surgical excision, cryotherapy, and laser therapy, each with its own set of advantages and disadvantages[2]. Recently, there has been interest in minimally invasive methods such as radiofrequency cauterization and topical common salt application. Radiofrequency cauterization offers a precise method of tissue ablation, potentially reducing recurrence rates by ensuring thorough removal of the lesion[2]. On the other hand, topical common salt application has emerged as a novel, non-invasive approach, showing promising results with minimal side effects and no scarring[3,4].

This study aims to compare the recurrence rates of radiofrequency cauterization and topical common salt application in the treatment of pyogenic granuloma. By evaluating these two methods, we hope to provide insights into their efficacy and safety, contributing to the development of optimal treatment strategies for PG.

Study Design: This study was designed as a prospective cohort study.

Study Centre: The study was conducted at the Department of Dermatology, Venereology, and Leprosy, M.G.M. Medical College & M.Y. Hospital, Indore, Madhya Pradesh.

Study Duration: The study was undertaken for a period of 12 months after obtaining approval from the Institutional Ethics Committee, spanning from January 1, 2023, to December 31, 2023.

Source of Data: 

A total of 50 cases of pyogenic granuloma visiting the outpatient department of Dermatology, Venereology, and Leprosy at M.G.M.M.C. & M.Y. Hospital, Indore, during the study period and satisfying the inclusion criteria were enrolled after obtaining written informed consent.

Sample Size Calculation: The sample size was determined based on the prevalence estimation from a recent epidemiological study indicating that pyogenic granuloma represents approximately 0.5% of all skin nodules in children (Joseph C. Pierson et al., 2020). The sample size was calculated using Lwanga & Lameshow's (2000) formula for cross-sectional surveys:

N = (Z² * P * Q) / D²

Where:

Z = 1.96 (normal variate corresponding to 95% confidence interval)

P = 0.5 (proportion with the disorder)

Q = 1 - P (proportion without the disorder)

D = 2 (margin of error)

By substituting values:

N = (1.96)² * 0.5 * 99.5 / (2*2) = 191.12 / 4 = 48 (approximately 50)

A convenient sampling technique was used, and patients were selected based on inclusion criteria from 8:00 AM to 2:00 PM at the outpatient facility of the Dermatology, Venereology, and Leprosy department. Recruitment ceased once the 12-month study period was completed.

Inclusion Criteria:

All consenting adults diagnosed with cutaneous pyogenic granuloma.

Exclusion Criteria: Patients were excluded if they met any of the following criteria:

Cases of mucosal pyogenic granuloma.

Patients on systemic or topical immunosuppressive drugs, antiretroviral therapy, antineoplastic drugs, or those already receiving treatment for pyogenic granuloma.

Study Procedure: All eligible patients presenting to the OPD were assigned into one of two treatment groups using a web-based randomization tool or Microsoft Excel:

Group A: Treated with radiofrequency cautery (RFC)

Group B: Treated with common salt application

Treatment Modalities:

Radiofrequency Cautery (RFC):

The lesion was anesthetized using a local injection of lignocaine with adrenaline.

Radiofrequency cautery was performed to ablate the lesion.

Common Salt Application:

White soft paraffin was applied over the perilesional skin.

Sufficient salt was applied to cover the entire lesion.

The area was occluded with a cotton gauze and secured with surgical adhesive tape.

All patients in both groups were followed up for 3 months to assess recurrence of the lesion post-treatment.

Data Collection and Analysis:

• Study subjects were recruited after obtaining informed consent.
• A detailed history and clinical examination were conducted to assess etiological factors such as age, gender, and occupation.
• Patients were given the option to choose their preferred treatment method after a thorough explanation of both procedures.
• Data was recorded and analyzed using SPSS version 22.0.
• Continuous variables were presented as Mean ± Standard Deviation (Min-Max), and categorical variables as numbers (%).
• Association of categorical variables was analyzed using the Chi-square test or Fisher’s exact test.
• Means and medians were compared using the Student’s t-test or ANOVA test as appropriate.
• A p-value <0.05 was considered statistically significant.

Table:1 Distribution of Study Population by Age Group, Gender, and History of Trauma

The study population consisted of 50 individuals, distributed across different age groups. The highest proportion (38.0%) belonged to the 15-25 years age group, followed by 26.0% in the 25-35 years group. The majority of participants were male (78.0%), while females made up 22.0% of the population. Regarding the history of trauma, 58.0% had a trauma history, while 8.0% were on associated medication.

Table:2 Distribution of Study Population by Site of Lesions, Size of Lesions, and Associated Symptoms

Among the study population, lesions were most commonly found on the head (54.0%), followed by extremities (30.0%) and trunk (14.0%). Regarding lesion size, 84.0% were larger than 10mm, while 16.0% were smaller than 10mm. Associated symptoms varied, with the majority experiencing bleeding (80.0%), while 24.0% reported pain and 12.0% were asymptomatic.

Table 3 Association between Treatment and Duration of After 1 Month

The above table shows the association between Treatment and Duration of After 1 Month.

Chi square test for association between two variables was applied, which shows that all association between Treatment and Duration of After 1 Month was found to be significant (P<0.05).

For RFC Treatment, the maximum value 80.0% was for No Scarring and the minimum value 20.0% was for Scarring.

Similarly for Common Salt Treatment, the maximum value 100.0% was for No Scarring and the minimum value 0.0% was for Scarring.

Table 4 Association between Treatment and Duration of After 3 Months

The above table shows the association between Treatment and Duration of After 3 Months.

Chi square test for association between two variables was applied, which shows that all association between Treatment and Duration of After 3 Months was found to be non-significant (P>0.05).

For RFC Treatment, the maximum value 92.0% was for No Recurrence and the minimum value 8.0% was for Recurrence.

Similarly for Common Salt Treatment, the maximum value 92.0% was for No Recurrence and the minimum value 8.0% was for Recurrence.

This study compares the recurrence rates and scarring outcomes of two treatment modalities for pyogenic granuloma: radiofrequency cauterization (RFC) and topical common salt application. Both treatments demonstrated comparable efficacy in preventing recurrence at 3 months, with notable differences in cosmetic outcomes.

At the 3-month follow-up, both RFC and common salt application showed a recurrence rate of 8% (Table 4). The chi-square test revealed no statistically significant difference between the two treatments (p=1.000p=1.000p=1.000). This indicates that both modalities are equally effective in preventing short-term recurrence.

These findings align with previous studies on salt therapy, such as Daruwalla et al., who reported a very low recurrence rate of approximately 2% after longer follow-up periods, suggesting that salt therapy is effective for complete resolution with minimal recurrence. The slight difference in recurrence rates may be attributed to variations in follow-up duration or patient compliance with treatment protocols [5] . Similarly, studies on RFC have shown its effectiveness in ablating vascular lesions with low recurrence rates, though specific data for pyogenic granuloma is limited [6] .A significant difference was observed in scarring outcomes at 1 month post-treatment (p=0.018p=0.018p=0.018) (Table 3). The common salt group exhibited no scarring (0%), while the RFC group showed scarring in 20% of cases. This finding highlights the cosmetic superiority of common salt therapy over RFC. Daruwalla et al. also reported no residual scarring in patients treated with salt therapy, emphasizing its suitability for lesions in cosmetically sensitive areas [5] . In contrast, RFC involves thermal ablation, which may lead to localized tissue damage and subsequent scarring.

The study population consisted primarily of younger individuals (38% aged 15–25 years), consistent with the peak incidence of pyogenic granuloma reported in literature. The male predominance (78%) diverges slightly from studies reporting equal gender distribution for cutaneous lesions, potentially reflecting regional variations or referral bias[6].

Lesions were most commonly located on the head (54%) and were predominantly larger than 10mm (84%). Bleeding was the most frequent associated symptom (80%), followed by pain (24%). These findings align with previous studies describing pyogenic granuloma as a vascular lesion prone to bleeding due to its friable nature.

The comparable recurrence rates and superior cosmetic outcomes of common salt therapy suggest it may be preferable for treating pyogenic granuloma, especially for lesions located on cosmetically sensitive areas such as the face. Salt therapy is also inexpensive, easy to administer, and minimally invasive, making it an ideal choice for pediatric patients or those seeking non-surgical options.

RFC remains a viable option for patients requiring rapid lesion removal or those who prefer clinic-based procedures. However, its potential for scarring should be considered when selecting treatment modalities.

Limitations

The study's short follow-up period may not capture late recurrences observed in other studies. Additionally, the sample size limits subgroup analysis based on lesion characteristics or patient demographics

Both RFC and topical common salt application demonstrate similar efficacy in preventing recurrence of pyogenic granuloma at 3 months. However, salt therapy offers superior cosmetic outcomes by eliminating scarring entirely. Given its effectiveness, affordability, and safety profile, common salt application represents an excellent first-line treatment option for pyogenic granuloma.

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