Two pediatric cases of pyogenic granuloma treated with imiquimod 5% cream: combined clinical and dermatoscopic evaluation and review of the literature.

Pyogenic granuloma (PG), also referred to as lobular capillary hemangioma, is a common, benign vascular proliferation of skin and/or mucous membranes, occurring most frequently in children and young people. First line therapy of PG consists of surgical excision. Alternative treatments such as curettage, cauterization, laser therapy and cryotherapy may require multiple sessions, pose unwanted complications and have the highest rate of recurrence. Imiquimod (IQ) 5% cream is a synthetic imidazoquinolin heterocyclic amine that enhances, through cytokine induction, both the innate and acquired immune pathways, resulting in immunomodulating, antiviral and antitumor effects; it is currently used in adults in the treatment of various skin disorders. Definitive data on its efficacy and safety on pediatric age groups are not established, but there are different case reports about its use in the treatment of molluscum contagiosum, ano-genital warts, haemangiomas and, recently, PG with 12 cases reported in literature. We report our experience on the use of topical IQ 5% cream in two cases of PG occurring in pediatric patients, with complete resolution of clinical and dermatoscopic features.