Topical brimonidine for pyogenic granuloma after paronychia-
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A 17-year-old teenager boy presented with suppuration of the first toe of both feet and excruciating pain. Doctors conducted surgical treatment of partial nail avulsion and lateral nailfolds excision as the clinical manifestations were consistent with paronychia of nail embedment, the lateral horns of the nail matrix were also excised.

On the 7th day after surgery, the operation site of the first toe of left foot developed pain and slight pyosis, the suture was removed on the 14th day as planned, but typical erythematous nodules and erosive surface gradually appeared in the next 22 days, consistent with the lesions of PG.

Due to the fear of pain during local anesthesia, post-surgery, and risk of recurrences, he refused all invasive treatments such as surgery. Upon the request of the patient, we treated him with conservative options. He was treated with wet compression of 0.5% topical brimonidine tartrate eye drops twice daily, after the lesion was disinfected by povidone-iodine. After several days of 0.5% topical brimonidine tartrate eye drops treatment, the pain was significantly relieved showing visible improvement. 15 days after effective treatment the skin lesions of PG improved with no perceived side effects such as drowsiness, hypotension, bradycardia, and others.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30794-3/fulltext?rss=yes
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