Umbilical Granuloma

Umbilical granuloma is a soft, moist, pink, usually pedunculated, friable lesion of granulation tissue that varies in size from 3 to 10 mm in length. Granuloma formation is more likely to occur when there is inflammation of the umbilical cord, usually due to infection, which also delays cord separation. 

Routine vigorous cleaning of wet umbilical stump or routine use of talc, antibiotic powders or creams, even alcohol has been seen to interfere with natural processes of umbilical stump drying and can result in granuloma formation.

The most common treatment for umbilical granuloma is topical 75% silver nitrate, usually applied once or twice a week for few weeks. Caution should be exercised in applying silver nitrate because it can cause chemical burns or staining of the surrounding skin.

Although data are limited, however topical clobetasol propionate has been reported to be successful. However, there are concerns regarding adverse effects (skin atrophy and hypopigmentation) and for systemic absorption. Ligation of the granulation tissue can be required in failed cases after ruling out umbilical masses, such as umbilical polyp. 

Practice tip : Its a common practice to apply a few crystals/particles of common salt once a day for 7-10 days where stump has not dried by 2 weeks age and there is a suspicion of granuloma.

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