Dermoscopy of Pyogenic Granulomas

T HE LESIONS ARE FROM THE LEFT PALM OF A 21-year-old woman (Figure 1), a finger of a 63-year-old man (Figure 2), and a finger of a 45-year-old man (Figure 3) (size bar, 4 mm in all figures). All 3 lesions reveal a similar pattern: red or pink homogeneous areas and a white scaly collarette (asterisks). The red or pink homogeneous areas likely represent the numerous small proliferating vessels that are present in the myxoid stroma of pyogenic granulomas, whereas the white collarette likely corresponds to the hyperplastic epithelium that partially or totally embraces the lesion in most pyogenic granulomas. The images also reveal white lines that intersect the pink homogeneous areas (arrowheads), which likely correspond histologically to the fibrous septa that surround the capillary tufts or lobules in the more advanced cases. These lesions are neither pyogenic (purulent bacterial infection) nor granulomatous and are probably better termed lobular capillary hemangiomas. They appear to be reactive in nature, but the underlying mechanism remains a mystery.