Abstract
BACKGROUND: Pyogenic granuloma (PG) is a benign vascular lesion frequently encountered in children and young adults. Although surgical excision is traditionally considered the standard of care, it may be limited by operative complexity, postoperative scarring, and patient discomfort. Sclerotherapy with polidocanol has recently emerged as a minimally invasive alternative, but direct comparative data in pediatric populations remain limited. METHODS: We conducted a retrospective cohort study of 30 pediatric patients diagnosed with PG and treated at our institution between January 2022 and February 2023. Fifteen patients underwent surgical excision and fifteen underwent intralesional sclerotherapy with 1% polidocanol. Clinical outcomes, recurrence rates, complications, and scar quality were evaluated. Scar assessment was performed using the Patient and Observer Scar Assessment Scale (POSAS 2.0) by both parents and two independent blinded observers. Statistical analysis included independent t-tests, χ (2) tests. RESULTS: Complete resolution was achieved in all patients (overall cure rate: 100%) with no recurrence during follow-up. In the sclerotherapy group, 93.3% achieved complete resolution after a single session, with one patient requiring a second session. The mean operative duration was significantly shorter for sclerotherapy compared with surgery (p < 0.05). Postoperative scarring was observed in 66.7% of the surgical group but only 6.7% of the sclerotherapy group (p < 0.01). POSAS scores for both patient and observer scales were significantly lower (indicating better cosmetic outcome) in the sclerotherapy cohort (p < 0.01). No major complications occurred. CONCLUSION: Both surgical excision and polidocanol sclerotherapy are highly effective for treating pediatric PG. However, sclerotherapy offers advantages including reduced scarring, shorter procedure time, and superior cosmetic results, suggesting it may be considered a first-line treatment. Larger prospective randomized trials are warranted to confirm these findings and optimize patient selection criteria.