Keywords
Acitretin; Pyognic granuloma; Granuloma telangiectaticum; Psoriasis; Plaque psoriasis
Abstract
Pyogenic granuloma is a bright red benign lesion which can result in bleeding and discomfort. The aetiology is unclear, however drugs, trauma and pathogens are some causes linked to their formation. We describe a case of a 92-year-old female who presented with a rapidly growing nodule on her right second toe with no history of trauma. She had previously been prescribed the retinoid acitretin for plaque psoriasis. After excision of the first lesion the patient presented with another lesion, this time on her left heel. Her lesions resolved on cessation of acitretin therapy. Histological analysis provided a diagnosis of acitretin induced pyogenic granuloma. It is well documented that pyogenic granulomas are rare side effects in acne and psoriasis patients who take retinoid treatment. Paradoxically, retinoids inhibit the formation of vascular endothelial growth factor and would be expected to inhibit rather than stimulate the formation of pyogenic granulomas. It is possible that retinoids favour trauma or share a proangiogenic target; retinoids decrease attachments between keratinocytes and cause nail brittleness. Resolution can occur spontaneously or on cessation of the drug.
Citation
Qureshi FU, Krishna SK, Sawant A, Barea A, Reeken S and Natkunarajah J. Non-Healing Lesions in a Patient with Chronic Plaque Psoriasis. SM Dermatolog J. 2017; 3(2): 1016.