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An 18-year-old woman presented to the outpatient dermatology clinic of the Hospital Universitario San Cecilio, Granada, Spain, in 2017 for a scheduled three-month follow-up appointment after having been prescribed 30 mg/day of oral isotretinoin for the control of severe acne. At the follow-up appointment, she reported multiple ulcerated exophytic dome-shaped lesions prone to haemorrhage in the intergluteal fold and pubic region [Figure 1]. She had no significant past medical history and did not report ever having had hidradenitis in the affected location nor any past trauma following hair removal.
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Figure 1
Clinical photographs of an 18-year-old patient with multiple ulcerated exophytic dome-shaped lesions located on the (A) inner side of both groins and (B) intergluteal fold.
The results of complementary tests, including a complete blood count, general biochemistry tests and urinalysis, were within normal limits. A histological examination of the largest lesion was compatible with a diagnosis of pyogenic granuloma (PG) [Figure 2]. Subsequently, the isotretinoin dose was reduced to 15 mg/day and a topical application of clobetasol propionate twice daily was administered. The patient reported the complete resolution of the lesions within three weeks.
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Figure 2
Haematoxylin and eosin stain at x2 magnification showing capillaries and venules with plump endothelial cells (arrowhead) separated into lobules by fibro-myxoid stroma (arrow).
Comment
Also known as capillary lobular haemangioma, PG is a benign vascular lesion that can compromise the skin or mucous membranes and usually occurs...