A 33 year old male with no past medical history presents for right hand pain. He works in construction. A few weeks ago, there was a wooden splinter in his palm that has grown into a nodule. He denies any drug use. Vital signs are within normal limits. The right upper extremity is neurovascularly intact with full range of motion. There is a 1.5 cm pedunculate lesion shown below. It is firm and minimally tender to palpation with no bleeding or drainage. Which of the following is the appropriate treatment?
A: discharge with dermatology follow up
D: incision and drainage
C: oral cephalexinÂ
D: topical mupirocin ointment
Answer: A. discharge with dermatology follow up
This patient is presenting with a pyogenic granuloma, a benign vascular tumor that classically occurs after minor trauma in young adults and pregnant women. It most commonly occurs in the hands or oral cavity and will recur without proper treatment. A dermatologist can confirm the diagnosis with a biopsy. Incision and drainage, oral cephalexin, or topical mupirocin ointment are useful in the management of abscesses and infected wounds but are not appropriate for a pyogenic granuloma. Definitive treatment includes surgical excision, laser therapy, or electrocautery.
References:
Holahan H, & Morrell D.S., & McShane D.B. (2020). Skin disorders: extremities. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.
