Topical Sirolimus Therapy for Agminated Pyogenic Granulomas: A Two-Case Report

Pyogenic granulomas (PGs) are benign vascular tumors that present as rapidly growing, friable papules that often bleed and cause cosmetic disfigurement. PGs generally respond well to treatments such as excision, laser, cryotherapy, topical imiquimod, and topical timolol, but agminated PGs can be distressing to patients and challenging to treat. Topical sirolimus, an mTOR inhibitor, is used in the treatment of other vascular anomalies but has not been previously investigated for use in PGs. We report two patients with agminated PGs who demonstrated improvement in size, color, and bleeding following treatment with topical sirolimus.