Source-Calado R, Calvão J, Pereira S, Ramos L. Pyogenic granuloma: a new therapeutic effect of salt? J Pediatric Child Health. March 2021; 57(3): 459-460. doi: 10.1111/jpc.15375. PMID: 33728785

New use of salt in the treatment of pyogenic granuloma

Pyogenic granuloma (PG) is a common benign vascular mucosal skin hyperplasia commonly seen in dermatology clinics. Although it is benign, it manifests as repeated bleeding events, causing severe anxiety in the patient. Although there are multiple treatments, relapses are common. A case series was recently described in the journal Clinical and Experimental Dermatology, describing the efficacy of table salt as a non-invasive treatment for PG.

This is a prospective, open-label, uncontrolled study of 50 PG patients treated with ordinary salt in a commercially available package. First apply white soft paraffin to the skin around the lesion, then cover the entire lesion with enough salt, and seal the area with surgical tape. Participants were asked to keep the dressing dry until it was changed the next day. For areas such as lips and genitals, these areas are not always able to stay dry, so patients are required to repeat the dressing when they are comfortable throughout the day.

The main result of the evaluation is the duration of complete regression of the lesion, defined as the absence of visual and dermoscopic findings of PG after salt application. Assess reduction in bleeding tendency, related complications such as burning sensation or secondary infection, and patient satisfaction level. All patients were followed up once a week for any complications until resolution, and then recurrence was followed up at 6 and 12 months after treatment.

In 100% of cases, complete regression of the lesion was observed without any remaining scars. The average time to complete resolution was 14.77 days (range 6-38 days). It was found that the PG on the mucosal surface (such as the lower lip) faded faster than the PG on the skin (the average fade time was 10 days and 18.3 days, respectively). It was found that there was a statistically significant positive correlation between the size of the lesion and the time required for complete regression (r = 0.69, P <0.001). The majority (94%) of patients reported that as an immediate response, the bleeding tendency of the lesion was reduced, which occurred on average 3.7 days after the start of treatment, and the size of the lesion gradually decreased until it subsided completely. One patient relapsed after 11 months of treatment. All patients reported being "very satisfied" (91%) or "satisfied" (9%) with the treatment.

Slight burning sensation, eczema reaction in the surrounding area, treat with emollient. No other adverse reactions or secondary skin infections were encountered.

The author hypothesized that the presence of salt in a closed environment would create a hypertonic chamber, which would produce a desiccation effect and cause the lesion to shrink. The author also believes that the time required for salt to dry the central feeder layer will be the time required for the lesion to completely resolve, which is why PG takes much longer to resolve than umbilical granuloma (UG). The longer the salt is in contact with the lesion, the faster it will fade away. In addition, mucosal lesions resolve faster than skin lesions.

In conclusion, salt therapy is safe, effective, cheap, self-safe to administer, easy to apply, no scars, and good response. It may be an ideal treatment for PG lesions

Source-Daruwalla SB, Ghate S, Dhurat R. Determine the effectiveness and safety of new salt treatment for purulent granuloma. Clinical experimental dermatology. October 2021; 46(7): 1243-1247. doi: 10.1111/ced.14658. Epub 2021 May 10th. PMID: 33764555.

Dr. Manoj Kumar Nayak completed his MBBS at the prestigious Bangalore Medical College and Research Institute Bangalore. He completed his Doctor of Medicine in Dermatology at AIIMS Rishikesh. He is actively involved in the field of dermatology, with particular interest in leukoplakia, immune bullous disease, psoriasis and procedural dermatology. His continued interest in academics and recent developments inspired the dialogue and collaboration with medicine.