23-Year-old male with multiple giant facial pyogenic granulomas being treated with combined topical timolol and steroid: A case report

INTRODUCTION AND IMPORTANCE: Pyogenic Granuloma (PG) commonly presents as a solitary, erythematous, non-tender, skin lesion, usually not exceeding 2.5 cm. Although Surgical excision is the first-line treatment, conservative treatments are recently developing. Solitary PG is well documented unlike multiple PGs, as the latter is rarely described in terms of its presentations and treatments. CASE PRESENTATION: This interesting case report describes a 23-year-old male who developed multiple PGs on the nasal area (2cmx2cm) and mandibular area (10cmx2cm) after sutures removal secondary to a recent history of trauma. The lesions regressed after successfully treated with two months of timolol drops and topical corticosteroids. Subsequently, intralesional corticosteroids injections were given once-per-month for two months, with residual fibrosis of the regressed lesion. CLINICAL DISCUSSION: While the most common site for multiple PGs is the interscapular region, this case reports giant, facial, multiple PGs followed suture removal. Although β-blockers were reported to successfully treat solitary PG, only a few cases were raised to discuss this treatment in terms of multiple PGs. This case completes the series and reports successfully-treated multiple PGs using a combination of topical timolol and steroid. CONCLUSION: This case supports the need to consider multiple PGs as a differential diagnosis following sutures removal even when it reaches rarely reported diameters. Also, it suggests topical timolol and steroids as an effective conservative treatment in similar cases of multiple giant PGs. Notably, the treatment failed to sidestep scar formation.