Novel use of common salt for the treatment of pyogenic granuloma

Pyogenic granuloma (PG) is a common benign vascular mucocutaneous proliferation seen commonly in dermatology outpatient department. Though benign it presents with recurrent bleeding episodes causing significant anxiety in patients. Although various treatments exist, recurrences are common. A case series describing the efficacy of table salt as a non-invasive treatment for PG was described recently in Clinical and experimental Dermatology journal.

It was a prospective open-label uncontrolled study of 50 patients of PG treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. Participants were instructed to keep the dressing dry until it was changed the following day. For areas such as the lips and genitalia, where keeping the area dry was not always possible, patients were asked to repeat the dressing as and when comfortable throughout the day.

The primary outcome assessed was the duration for complete resolution of the lesion, defined as the absence of visual and dermoscopic findings of PG since the salt application. Decrease in bleeding tendency, associated complications such as burning sensation or secondary infection and level of patient satisfaction were assessed. All patients were followed up for any complications on a weekly basis until resolution, and then followed up for recurrence at 6 and 12 months after therapy.

Results

Complete resolution of the lesion without any residual scar was seen in 100% of cases. The mean time for complete resolution was 14.77 days (range 6–38 days). PGs on mucosal surfaces such as the lower lip were found to resolve faster than those on the skin (mean resolution time 10 vs. 18.3 days, respectively). A statistically significant positive correlation was found between the size of the lesion and time taken to complete resolution (r = 0.69, P < 0.001). The majority (94%) of the patients reported a decrease in the bleeding tendency of the lesion as an immediate response, occurring in a mean of 3.7 days into treatment, followed by a gradual reduction in the size of the lesion until complete resolution. Recurrence was noted in one patient after 11 months of resolution. All patients reported being either 'highly satisfied' (91%) or 'satisfied' (9%) with the treatment.

Adverse events

A mild burning sensation, eczematous reaction in the surrounding area were, which was managed with an emollient. No other adverse effects or cases of secondary cutaneous infections were encountered.

The authors hypothesized that the presence of salt inside the occluded environment creates a hyperosmolar chamber, which results in a desiccant effect that causes shrinkage of the lesion. The authors also believed that the time taken for the salt to desiccate that central feeder will be the time taken to produce complete resolution of the lesion, which is why PGs take much longer than umbilical granulomas (UGs) to resolve. The longer the period of contact of the salt with the lesion, the faster the resolution. Furthermore, mucosal lesions resolved more quickly than cutaneous lesions.

To conclude salt therapy being safe, effective, cheap, which can be safely self administered, easy to apply with lack of scarring and excellent response, could be an ideal treatment for PG lesions

Source- Daruwalla SB, Ghate S, Dhurat R. Establishing the efficacy and safety of the novel use of common salt for the treatment of pyogenic granuloma. Clin Exp Dermatol. 2021 Oct;46(7):1243-1247. doi: 10.1111/ced.14658. Epub 2021 May 10. PMID: 33764555.