Discussion
PG is a common acquired vascular tumor that is more common in the
pediatric age group. The lesions present as rapidly growing
papulonodules that are extremely friable, frequently ulcerate, and may
bleed profusely with minor trauma. They appear mostly on the face,
trunk,and distal extremities. While the etiology of PG remains unclear,
the possible predisposing factors that affect the pathogenesis include
trauma, infections, elevated female sex hormones level, viral
oncogenesis, microscopic arteries venous anastomosis, and growth
factors.[1‑4].PG of different sizes occurs often as single lesions
and multiple disseminated lesions are a rare form of PG, and in general,
burns and widespread traumas may play a role in this form of PG. PG
develops over the burned area between 1 and 4 weeks following burns and
may be infected with bacteria and fungi.As in other cases in the
literature in English, there were 25 cases of disseminated PG following
burn from 1978 to 2020.[4‑18]
The cases occurred approximately between 1 and 4 weeks following burning
mostly secondary to
milk (nine cases), nine cases of scald burn, one case provoked by hot
water, and four thermal burns or flames and two cases are not mentioned.
Surprisingly, in our patient, the etiology was oil. In a majority of
cases,the lesions developed following the second‑degree burn [Table
1]. Differential diagnosis includes amelanotic melanoma,squamous cell
carcinoma, angiosarcoma, Kaposi sarcoma, hemangioma, bacillary
angiomatosis, metastatic visceral malignancies, and granulation tissue.
[14] These entitieswere ruled out both by clinical findings,
histopathological studies, and/or microbiological cultures. Conservative
treatment including wound management and antibiotic could be chosen
first, especially when large PG is on the face or other important areas
of the body. As PG can involve the reticular dermis, pulse dye lasers,
cauterization, and shave excision may not be able to reach the entire
PG, and these methods of treatment have a recurrence rate of
43.5%.[20]
In our patient, the lesions were surgically excised and followed by
electrosurgery of the base, and no occurrence was observed during 6
months.On a basic scale level, we think that the burn etiology
and not the burn injury itself is important because all similar cases
have the same etiology that may not
be a coincidence, and milk proteins might cause the development of PG;
to the best of our knowledge, the most probable etiology is not a trauma
or infection itself, but an idiosyncratic response to previous insults
with the accompanying release of various proliferative and growth
factors such as endothelial growth factor,fibroblast growth factor, and
interleukin 1 B may play a role.[10,20]
Oil burning is reported in our case as a cause ofdisseminated PG for the
first time so more research
focusing on the etiology is needed, and the reasons why every trauma
could not cause PG and why the
same patient could not develop PG at later trauma areunclear.
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