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Dermatoscopy of umbilical granuloma
Rubina Jassi, Sarita Sanke, Ram Chander
Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| Date of Submission | 26-Mar-2020 |
| Date of Decision | 18-Jun-2020 |
| Date of Acceptance | 20-Jul-2020 |
| Date of Web Publication | 19-Sep-2020 |
Correspondence Address:
Sarita Sanke,
Department of Dermatology and STD, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi - 110 001
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/idoj.IDOJ_171_20
Umbilical granulomas (UG) are formed by excessive granulation tissue proliferation, post umbilical cord shedding presenting as soft vascular nodule, usually asymptomatic but may be tender secondary to superadded infection.
A 2-month-old baby presented with complaints of erythematous nodule of size 1.5 × 1.5 cms over the umbilicus [Figure 1]a after the shedding of the umbilical cord. Mother did not notice any discharge or tenderness except for a single episode of bleeding from the nodule which subsided of its own. On the basis of history and clinical appearance, the diagnosis of umbilical granuloma was established. Dermatoscopy (Dermlite 3N, polarized, 10×) of the nodule showed a milky red background (blue asterisk) with multiple fine linear (green arrow), dotted (yellow arrow) and tortuous vessels (white arrow) [Figure 1]b and [Figure 1]c. These structureless milky red background corresponds to the hyperproliferative fibroblasts, vascular endothelial cells and granulation tissue, while the neoangiogenesis is seen as superficial vascular patterns.[1] | Figure 1: (a) Umbilical granuloma of size 1.5 × 1.5 cms with brown crusting present over the margins of the granuloma. (b and c) Dermatoscopic image (Dermalite, 3N, polarized, 10×) of umbilical granuloma showing milky white background (blue asterisks) studded with linear (green arrow), dotted (yellow) and tortuous (white arrow) vessels over the surface
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Our findings were similar to previous reported dermatoscopic findings of UG by Ancer-Arellano J et al.[2] Patient was treated with topical application of 30% trichloracetic acid once a week followed by resolution of the lesions. Other known treatment options include topical silver nitrate, table salt application and surgical excision.
Vascular lesion seen over umbilicus in these age groups are umbilical granuloma, umbilical polyp and patent urachus. UG is the most common neonatal umbilical anomaly.[3] Umbilical polyp is comparatively are rare entity seen as erythematous umbilical nodule. Clinically, they are potential indicator of intestinal obstruction and histopathologically they represent intestinal mucosa.[4]
Dermatoscopic features of these entity haven't been described in literature yet. Furthermore, findings of common differentials need to be evaluated for the dermatoscopic features to avoid diagnostic dilemma.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Brady M, Conway AB, Zaenglein AL, Helm KF. Umbilical granuloma in a 2-month-old patient: Histopathology of a common clinical entity. Am J Dermatopathol 2016;38:133-4.  |
| 2. | Ancer-Arellano J, Argenziano G, Villarreal-Martinez A, Cardenas-de la Garza JA, Villarreal-Villarreal CD, Ocampo-Candiani J. Dermoscopic findings of umbilical granuloma. Pediatr Dermatol 2019;36:393-4. |
| 3. | Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am 2004;51:819-27. |
| 4. | Pacilli M, Sebire NJ, Maritsi D, Kiely EM, Drake DP, Curry JI, et al. Umbilical polyp in infants and children. Eur J Pediatr Surg 2007;17:397-9. |
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