What is Umbilical Granuloma
- Umbilical granulomas are small, red, broad-based, friable papules that develop if the umbilicus does not re-epithelialize completely; therefore they are not usually present at birth. Umbilical granulomas occur most commonly during the first few weeks of life.
- Umbilical granuloma is a small mass of scar tissue in a baby’s belly button. When a newborn baby’s umbilical cord is cut, a stump of tissue remains attached to the baby’s belly button.
- This stump usually falls off 1–2 weeks after the baby is born. Usually, when the stump falls off, the area heals and becomes covered with skin. However, sometimes an umbilical granuloma forms.
- After cord separation, a small mass of granulation tissue may develop at the base. These granulomas consist of true granulation tissue with fibroblasts and abundant capillaries; the granulomas range in size from 1 mm to approximately 1 cm. The surface often has a pedunculated appearance.
- Normally, the cord dries and separates in 7–14 days. The open surface epithelializes and scars down in an additional 1–2 weeks. Excessive moisture and low-grade infection may result in the growth of exuberant granulation tissue to form an umbilical granuloma.
- Cauterization with silver nitrate or desiccation with repeated applications of isopropyl alcohol usually produces rapid healing of the granuloma. In some cases, a less friable, more firm nodule may be present
- Most small umbilical granulomas will spontaneously dry out, and the surrounding skin will contract and heal the umbilicus
Causes of Umbilical Granuloma
The exact cause of this condition is not known. It may be related to:
- A delay in the time that it takes for the umbilical cord stump to fall off.
- A minor infection in the belly button area.
What are the symptoms of Umbilical Granuloma?
Symptoms of this condition may include:
- A pink or red stalk of scar tissue in your baby’s belly button area.
- A small amount of blood or fluid oozing from your baby’s belly button.
- A small amount of redness around the rim of your baby’s belly button.
They can be distinguished from umbilical polyps by the lack of serous, mucoid, or bloody discharge
These granulomas does not cause your baby pain as the scar tissue in an umbilical granuloma does not contain any nerves.
How is it diagnosed?
- Physical examination by the pediatrician
- Ultrasonography to differentiate umbilical granulomas from umbilical polyps
The sonography is highly beneficial for the differential diagnosis of umbilical polyps and granulomas in children based on correlations with pathologic findings.
Ultrasonography typically shows the deep-seated, hypovascular nodules with cyst formation surrounded by thick echogenic walls which confirm the diagnosis of umbilical polyps.
In contrast, superficially located hypervascular hypoechoic solid nodules in young infants revealed on the Ultrasonography indicate the umbilical granulomas.
Dermoscopic findings of Umbilical Granuloma
Dermoscopic findings in umbilical granuloma are vascular polymorphism comprised of linear irregular and arborizing vessels with structureless areas distributed over a milky‐red background.
The increase of angiogenesis and neovascularization is represented by the linear irregular and arborizing vessels.
Structureless areas over an irregularly milky‐red background are originated by the proliferation of vascular endothelial cells and fibroblasts, with capillary and granulation tissue formation.
What is the Treatment?
If your baby’s umbilical granuloma is very small, treatment may not be needed. Your baby’s health care provider may watch the granuloma for any changes. In most cases, treatment involves a procedure to remove the granuloma. Different ways to remove an umbilical granuloma include:
- Applying a chemical (silver nitrate) to the granuloma.
- Applying a cold liquid (liquid nitrogen) to the granuloma.
- Tying surgical thread tightly at the base of the granuloma.
- Applying a cream (clobetasol) to the granuloma. This treatment may involve a risk of tissue breakdown (atrophy) and abnormal skin coloration (pigmentation).
The granuloma tissue has no nerves in it, so these treatments do not cause pain. In some cases, treatment may need to be repeated.
In some infants, secondary infection results in a condition called as omphalitis. In such a scenario, aggressive antibiotic treatment is mandatory to prevent further infection like peritonitis and sepsis.
Umbilical granulomas are very different from a similar condition called as umbilical polyps.
Persistence of a duct called the omphalomesenteric duct or otherwise termed as the urachus results in umbilical polyps.
A discharge which is typically mucoid from the tip of the firm, red polyp. This polyp when examined under microscope, histologically demonstrates gastrointestinal or urinary tract mucosa. Surgical excision is necessary for such lesions.
Occasionally, an umbilical granuloma will resist efforts at silver nitrate cauterization.
Such a granuloma should be carefully evaluated because it may, in fact, represent a persistent ectopic (usually intestinal) mucosa rather than a granuloma, related to incomplete disappearance of the vitelline duct.
Such a persistent mucosa demands careful evaluation to assess whether any deeper associated connections exist, such as an (uncommon) omphalomesenteric duct.
A persistent mucosa ultimately will require excision; otherwise, it will continue to produce serous or mucous drainage.
What is the Prognosis
Umbilical granulomas are of little concern as they can be easily treated with silver nitrate. However, these lesions may be difficult to clinically differentiate from congenital anomalies of the urachus and omphalomesenteric duct.
In general, if the lesion is large, exophytic, and has a broad base (>0.5 cm), a referral to a pediatric general surgeon is indicated prior to treatment with silver nitrate.
Follow these instructions at home:
- Follow instructions from your baby’s health care provider for proper care of your the umbilical cord stump.
- If your baby’s health care provider prescribes a cream or ointment, apply it exactly as directed.
- Change your baby’s diapers frequently. This helps to prevent excess moisture and infection.
- Keep the upper edge of your baby’s diaper below the belly button until it has healed fully.
Contact a health care provider if:
- Your baby has a fever.
- A lump forms between your baby’s belly button and genitals.
- Your baby has cloudy yellow fluid draining from the belly button.
Get help right away if:
- Your baby who is younger than 3 months has a temperature of 100°F (38°C) or higher.
- Your baby has redness on the skin of his or her abdomen.
- Your baby has pus or bad-smelling fluid draining from the belly button.
- Your baby vomits repeatedly.
- Your baby’s belly is swollen or it feels hard to the touch.
- Your baby develops a large reddened bulge near the belly button.