Umbilical granuloma
Umbilical granuloma is the most common anomaly of the umbilicus in neonates and infants 1. A granuloma is focal collection of inflammatory cells at sites of tissue infection and includes activated macrophages (epithelioid cells), Langhans’ giant cells, and lymphocytes. An umbilical granuloma is a moist, red lump of tissue that can form on a baby’s navel (belly button). Umbilical granuloma is characterized by an overgrowth of granulation tissue that persists at the base of the umbilical cord after its separation. The granulation tissue in the umbilical granuloma is soft, 3–10 mm in size, vascular, dull red or pink in color, and may show a seropurulent secretion 2. Histologically, umbilical granuloma consists of granulation tissue, which is composed of fibroblasts, inflammatory cells, and vascular endothelial cells set in an edematous stroma 3.
Umbilical granuloma can be seen in the first few weeks of life, after the umbilical cord has dried and fallen off. Umbilical granuloma is usually a minor problem that looks worse than it is. An umbilical granuloma does not cause pain. It may ooze a small amount of fluid that can make the skin around it red and irritated.
Your child’s doctor may treat the umbilical granuloma if it doesn’t go away by itself. The doctor may:
- Apply silver nitrate to shrink and slowly remove the umbilical granuloma. It may take 3 to 6 doctor visits to finish the treatment.
- Use surgical thread to tie off the umbilical granuloma at its base. The thread cuts off the blood supply to the umbilical granuloma. This will make it shrivel and fall off.
Neither of these treatments is painful.
See your baby’s doctor now or seek immediate medical care if:
- Your baby has signs of an infection, such as:
- Increased swelling, warmth, or redness.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
- Your baby cries when you touch the navel or the skin around it.
Watch closely for changes in your child’s health, and be sure to contact your doctor if your child has any problems.
Umbilical granuloma treatment
Umbilical granuloma can be seen in the first few weeks of life, after the umbilical cord has dried and fallen off. Umbilical granuloma is usually a minor problem that looks worse than it is. An umbilical granuloma does not cause pain. It may ooze a small amount of fluid that can make the skin around it red and irritated.
The most commonly used treatment for umbilical granuloma is silver nitrate cauterization 4. However, chemical burns to the periumbilical area, eyelids, and so on caused by silver nitrate cauterization have been reported as possible complications 5. Various studies have investigated alternatives to silver nitrate cauterization, including common salt 6, cryosurgery or electrocautery 7, excision and application of absorbable hemostatic materials 8, double ligatures 9, and alcoholic wipes 10. Topical steroid ointment treatment for umbilical granuloma has gained wide attention due to the advantages of effectiveness and simplicity 11. Brodsgaard et al 11 raised the possibility that topical clobetasol propionate (0.05%), may be as effective as silver nitrate cauterization for treatment of umbilical granuloma. Patients were applied with 0.12% betamethasone valerate ointment to the lesion twice a day after washing or bathing by parents. No occlusive dressing was used and no attempt was made to dry the lesion. Prior to treatment, doctors informed the parents about the following possible side effects: 1) local infection at the umbilicus; and 2) stinging, pigmentation, itching, irritation or skin-color changes. Parents were explained to avoid occlusive dressings in order to avoid enhancement of drug absorption. Considering that silver nitrate cauterization carries a distinct risk of chemical burns and that the overall efficacy of topical steroid ointment treatment is similar to that of silver nitrate cauterization, topical steroid ointment might be considered as a good alternative in the treatment of neonatal umbilical granuloma due to its safety and simplicity 1. However, that study was not large enough to show superiority or non-inferiority to silver nitrate cauterization.
Your child’s doctor may treat the umbilical granuloma if it doesn’t go away by itself. The doctor may:
- Apply silver nitrate to shrink and slowly remove the umbilical granuloma. It may take 3 to 6 doctor visits to finish the treatment.
- Use surgical thread to tie off the umbilical granuloma at its base. The thread cuts off the blood supply to the umbilical granuloma. This will make it shrivel and fall off.
Neither of these treatments is painful.
How you can care for your child umbilical granuloma at home
- Clean the area at least once a day and as needed during diaper changes or baths.
- Soak a cotton swab in warm water and mild soap. Squeeze out the excess water. Gently wipe around the sides of the navel. Also wipe the skin around the navel.
- Gently pat the area dry with a soft cloth.
- Keep the area dry.
- Keep your baby’s diaper folded below the navel until the umbilical granuloma is healed. If that doesn’t work well, try cutting out an area in the front of the diaper (before you put it on your baby) to keep the navel exposed to air.
- Bathe your baby carefully. Keep the area above the water level until it heals.
- Ogawa C, Sato Y, Suzuki C, et al. Treatment with silver nitrate versus topical steroid treatment for umbilical granuloma: A non-inferiority randomized control trial [published correction appears in PLoS One. 2019 Jun 11;14(6):e0218205]. PLoS One. 2018;13(2):e0192688. Published 2018 Feb 13. doi:10.1371/journal.pone.0192688 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811027
- Carlo WA. The Umbilicus Nelson TEXTBOOK OF PEDIATRICS; 20th EDITION 2015: pp. 890–891
- Umbilical Granuloma in a 2-Month-Old Patient Histopathology of a Common Clinical Entity. The American Journal of Dermatopathology: February 2016 – Volume 38 – Issue 2 – p 133-134 doi: 10.1097/DAD.0000000000000429
- Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am. 2004;51(3):819–27, xii. doi: 10.1016/j.pcl.2004.01.010
- Majjiga VS, Kumaresan P, Glass EJ. Silver nitrate burns following umbilical granuloma treatment. Arch Dis Child. 2005;90(7):674 doi: 10.1136/adc.2004.067918
- Kesaree N, Babu PS, Banapurmath CR, Krishnamurthy SN. Umbilical granuloma. Indian Pediatr. 1983;20(9):690–2.
- Sheth SS, Malpani A. The management of umbilical granulomas with cryocautery. Am J Dis Child. 1990;144(2):146–7.
- Nagar H. Umbilical granuloma: a new approach to an old problem. Pediatr Surg Int. 2001;17(7):513–4. doi: 10.1007/s003830100584
- Lotan G, Klin B, Efrati Y. Double-ligature: a treatment for pedunculated umbilical granulomas in children. Am Fam Physician. 2002;65(10):2067–8.
- Daniels J, Craig F, Wajed R, Meates M. Umbilical granulomas: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2003;88(3):F257 doi: 10.1136/fn.88.3.F257
- Brodsgaard A, Nielsen T, Molgaard U, Pryds O, Pedersen P. Treating umbilical granuloma with topical clobetasol propionate cream at home is as effective as treating it with topical silver nitrate in the clinic. Acta Paediatr. 2015;104(2):174–7. doi: 10.1111/apa.12824
