nose piercing granuloma treatment

The timetable of when your piercing was done can help you figure out if youre dealing with agranuloma. New lesion Sea salt water is also one of the best home remedies for treating a bump inside your nose. DOI: Suggested aftercare guidelines for body piercings. If you see a formation around your piercing site and you arent sure if its a keloid, schedule an appointment with your doctor or piercer. Pyogenic granulomas arent contagious. Granuloma annulare . But pyogenic granulomas are rarely related to infection, and they dont generally contain white blood cells or pus. The reaction can take two to four weeks to fully fade. This may help slow your body's exaggerated healing reaction. With the rising popularity of nose piercing, the last thing that you expected was that a bump would appear on the pierced nose. Using simple home remedies such as sea salt hot compresses and tea tree oil, among others can help to get rid of such a bump. To make the sea salt home remedy to get rid of an infected nose piercing bump, do the following: The warm water in the compress increases blood circulation to the infected nose piercing to speed up the healing process and the salt helps any pus to drain from the wound. Hate to break it to you, but you very well might be allergic to that cool piece of jewelry you picked out for your new piercing. Most often, you'll have redness and swelling around the infected area and your nose may feel extra tender. If youd prefer, your piercer can do it for you. It then stabilizes into a raised, reddish nodule that's typically smaller than 2 . J Oral Sci. doi:10.2334/josnusd.48.167. What is granuloma on a nose piercing? Don't switch out your nose jewelry and don't move it any more than is needed for cleaning, King says, as this can interrupt the healing process and cause irritation. Please consult a healthcare practitioner before using tattoo/skincare products that may interfere with medications or known conditions. This study describes the clinical characteristics and possible etiologic factors in a series of patients with pyogenic granuloma. All rights reserved. Many piercers advise using a sea salt water soak to clean the pierced area and to soften any discharge that has accumulated. The 2 most common reasons for a bump around a nose piercing are some kind of trauma or infection in the pierced area (nose piercing infection). Greig JE, et al. Methods: All adult patients with a histologic diagnosis of pyogenic granuloma of the nasal cavity were . How to treat it: "Hypoallergenic piercings should be used, such as surgical steel or titanium," King advises. 3) Keloids The last possibility that a nose piercing bump could be is a keloid. Nose piercing healing depends on where you get your nose pierced, what kind of jewelry you use, and how well you take care of the piercing. If there isnt an infection present then the bump shouldnt take too long to go down. If your pustule wont drain on its own with warm water saline compresses and you need to have it lanced, you should head to a doctors office to have it done. Dry your hands with a paper towel, then proceed to clean your piercing. From here, simply soak it in a half-cup of lukewarm water for around five minutes. a granuloma, which is a lesion that occurs on average 6 weeks after a piercing. Scientists arent sure exactly how common they are, though, because many cases arent reported. Before touching your nose piercing for any reason, you should always wash your hands thoroughly using warm water and liquid soap. Body piercing aftercare Inflammatory changes and signs of haemorrhage are secondary. 8 tips for treating an infected nose piercing. These keloids majorly appear after incurring injuries. Keloids are raised scars that extend beyond the initial injury and if youve gotten a keloid in the past, youre more prone to them in the future. The information contained on AuthorityTattoo is intended for informational and educational purposes only. While you do want your pustule to naturally drain, you should never lance it yourself without having the proper, sterile equipment. Laser treatment to destroy the abnormal tissue. A dermatologist can freeze the growth, inject steroids, or use laser therapy to help it heal. Keloid bumps can be extremely difficult to get rid of without external help from a Board Certified Dermatologist. A reputable piercing salon will give you written instructions on after-piercing care. This may be due to body allergic reaction to some materials such as nickel. Granulomas may go away on their own, but it could take months. Theyll offer their expert advice on your symptoms and provide guidance for proper treatment. Retinoids (vitamin A compounds often used to improve or heal skin). What to do: If you think youve got an allergy, swap out your jewelry for a hypoallergenic version, like surgical stainless steel, sterling silver or 14-karat gold. Sometimes, inflammation and swelling can cause a small bump to form around the area. Your nose is part of an area known as the danger triangle, which means infections that start there can, in rare cases, impact the rest of your body and even your brain. Cleveland Clinic is a non-profit academic medical center. Other mucosal sites that can be affected include the conjunctiva and nasal mucosa. If the nasal swelling continues after the two previous treatments, apply direct pressure to the . In fact, the studies showed that chamomile helps wounds heal quicker than corticosteroids, medicated creams which are used to heal skin lesions.7. Theyre generally more common in children around 6 years old, teens, young adults and people who are pregnant. If you're prone to keloids, you may have to give up your nose piercing and know that future piercings may also cause keloids, so it's probably best to avoid them. Avoid removing your nose jewelry as it can aggravate your bump and try to be as gentle as you can possibly be with the cleaning process. Vascular structures are usually present and there are red homogenous areas with no clear lacunar pattern. Once the water has drawn out the chamomile contents, use a cotton ball to soak some of it up and press it against the bump for 5-10 minutes. Squeeze out some of the water and place the hot chamomile tea bag on the infected nose piercing bump. They can be removed through surgery, but even then, in some cases, they might come back. Doing so may cause your nose tissue to tear. If you've had an ear or nose cartilage piercing, small lumps can sometimes form around the piercing. Or, bacterial infections from unclean hands or not keeping the pierced area clean could cause a Staphylococcus bacterial infection in the wound. Raw apple cider vinegar can help to get rid of the discomfort and irritation caused by a bump that is due to nose piercing. Treating or removing triggering factors is important to minimise the risk of recurrence. Ouch! Curettage, to scrape it away, and cautery, to seal the skin with heat. Pyogenic granulomas tend to ooze, and they break and bleed easily. The reason why aloe vera can help treat an inflamed red bump that was caused by nose piercing is because its antioxidant and anti-inflammatory activities reduce skin redness and promote healing.10 Aloe vera also boosts the skins production of collagen so that regular application of it makes your skin look and feel better.11 You can also use aloe vera to reduce the appearance of scars. Healthy and Natural World is supported by its audience. If you dont experience any irritation or inflammation, you can apply the solution to your nose piercing. Failing this, or if your situation significantly worsens, then its advisable to see a doctor as quickly as possible in case youve managed to contract a nasty infection. Below are the five main causes of bumps around the site of a nose piercing: As its name indicates, this nose bump is full of pus. Dry using a paper towel. You can also use virgin coconut oil with tea tree to treat the infected nose piercing. If you have a history of forming keloids or if you have a parent who has them, tell your piercer about that before having the procedure done. If youre developing a keloid around your piercing, remove the jewelry right away and talk to a dermatologist about next steps. Instead, visit your piercer so they can swap out the jewelry for you. A pyogenic granuloma starts off as a lesion with a rapid growth period that usually lasts a few weeks. Nose Piercing Granuloma - Granuloma is a development tissue that shows up on the following edge of the nose puncturing as a rule by the penetrated opening. You should use a fragrance-free antimicrobial soap or your piercer's recommended cleanser to clean your piercing and the surrounding area. An 18 year old student who has undergone piercing of her ears in a piercing parlor 2 months back . Pyogenic granuloma has many synonyms including granuloma gravidarum or pregnancy tumour when occurring in pregnancy. White linear rail lines are an important feature. If you dont, see your piercer. Like chamomile,tea treehas some great healing properties. All Rights Reserved. Tea tree oil is extremely powerful for killing germs and bacteria, so it can heal your nose as long as you use it. Your piercer can provide you with a more specific recommendation. Some of our other awesomely-helpful guides: If youve had your ears pierced in the past and you had reactions to a certain type of metal in your earrings, tell your piercer. The surface of a pyogenic granuloma starts smooth but can become bumpy or crusty. Advertising on our site helps support our mission. (And if youre reading this before youve been pierced, just choose one of those metals to begin with!). How Do Nose and Septum Piercings Look On a Big Nose? You're more likely to develop a keloid if you have a genetic predisposition or you have a darker skin tone. The medication makes your skin more sensitive to light, so light therapy can be more effective. Can Putting Garlic in Your Nose Relieve Congestion? Sometimes, an injury to the skin results in a pyogenic granuloma, a little bump that contains extra blood vessels that form to try to protect you. You can alternate between using a salt solution and a chamomile solution. A nose piercing can heal and maintain itself well with regular cleanings. It is described by swelling and in the long run ends up noticeably red. These effective home remedies can also help to treat an infected nose piercing bump and help it heal faster. These commonly appear on skin that has been damaged or has a foreign object (nose stud or ring) in it. By the end of this article, youll be equipped with everything you need to know in order to deal with your own little nose bump. The exact cause of pyogenic granulomas is unknown. Tea tree oil also acts as an anti-inflammatory to help reduce redness, itching, and inflammation in the infected bump on your pierced nose. Sometimes, bacteria can get in the wound and cause an infection, which in turn can cause a lump to form as the body tries to fight and force out the infection-causing bacteria. Pimples or Bumps on Eyelids: Causes and Treatments Is your piercing predestined for removal? According to the Body Jewelry Shop, the presence of keloid next to the pierced hole on the nose can make new piercings take longer to heal. Patterson JW. To retain the warmth, soak a new piece of paper towel and reapply every 2 minutes or so. Normal saline wound dressingis it really normal? Tea tree is a natural antifungal, antiseptic, and antimicrobial agent. Hold the salt water compress on the infected bump on your nose for a few minutes at a time. With any kind of body piercing, it is important to take good care of the pierced area. However, most dermatologists follows up with monthly shots of corticosteroids to completely flatten the keloid. Apply the compress 23 times a day for relief from an aching nose piercing. To avoid infection, make sure to clean your piercing twice daily with a saline solution. Use Sea Salt solution This the best natural way to help remove inflammation and treat an infection. Granuloma pyogenicum as a complication of decorative nose piercing: Report of eight cases from eastern India. Keloids generally don't hurt but can become irritated if they rub up against your clothes. The research shows that it is very helpful in treating nose piercing bumps and during treatment, the affected . 3. They may be able to reduce the keloid with corticosteroid injections. Depending on which treatment you use, it can take a few months for keloids to be fully treated. Tea tree oil: a review of antimicrobial and other medicinal properties Skin biopsy Treatment Granuloma annulare can clear on its own over time. These soft bumps are usually pinkish, reddish or even blackish-brown, and they ooze or bleed easily. Your body views the piercing as an invader and may react by causing itching, swelling, and blistering at the site. It could be the result of a variety of reactions. We do not endorse non-Cleveland Clinic products or services. Always use a cotton swab and a saline solution. She has a master's degree in social work from UPenn and is interested in the intersection of health and social justice. All rights reserved. How to treat it: If the tissue damage was minor, such as from a minor blow to your nose, you likely won't need to see a doctor and the bump should improve with time. Shop for therapeutic-grade tea tree oil online. Careful oral hygiene Dental treatment of oral trauma caused by teeth Removal of adjacent piercings. If you have any suggestions and queries you can contact us on the below details. In the aftermath of piercing your nose, you should keep off from touching the healing scar with dirty hands that might contain germs thus hindering the healing process resulting in an infection on the nose. Skin sensitivity testing for tea tree oil. Keloids dont go away on their own, either. They may occur from allergies, genetics, poor aftercare, irritation, trauma, or sometimes just bad luck. Its often mixed with other metals and used to make various everyday items. Dental treatment of oral trauma caused by teeth. Not only is it antiseptic and antimicrobial in nature, but its also great at soothing inflammation around the piercing. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.aocd.org/page/PyogenicGranuloma), (https://dermnetnz.org/topics/pyogenic-granuloma), (https://www.ncbi.nlm.nih.gov/books/NBK556077/), Visitation, mask requirements and COVID-19 information, Hormonal changes, such as pregnancy or the use of. Your piercing bump or lump is likely to be a granuloma! This article is provided with the understanding that it does not constitute medical or professional advice or services. This may include: Pyogenic granuloma rarely resolves spontaneously except post-partum for lesions associated with pregnancy. Use a clean piece of paper towel to gently pat the area dry. Soak a chamomile tea bag in a cup, as you would if you were making a cup of tea. Contact your healthcare provider if you develop any signs of a skin infection, such as: A pyogenic granuloma is a noncancerous, raised tumor on your skin or mucous membranes. Causes for the bumps range from irritation to excessive scar tissue known as keloids or granulomas. To get rid of a nose piercing bump that is the result of a granuloma or keloid, you should visit your doctor or dermatologist. Treatment: It's better to let a granuloma heal naturally once you've noticed it. Pyogenic granulomas are relatively common, particularly during pregnancy. They bleed easily due to having many blood vessels and can appear after you've had an . If youve already had a reaction to nickel, for example, you need to avoid jewelry that uses that metal when you get your nose pierced. You should also clean gently with soap and water.. Gently rub the swab around the infected nose piercing. ACV is a natural disinfectant that can help to destroy bacteria thanks to the acetic acid in it. Chamomile Tea is known for resolving inflammation and redness so you can place the warm bags around the region and if it loses heat then dip into the hot water again so that it heats up again. As macrophages surround and isolate the foreign body, some of them will fuse to form multinucleated giant cells. Pyogenic granuloma can bleed profusely and frequently with minor trauma, resulting in anaemia. If youve carefully managed to follow all of the advice within this article and your nose piercing is still not looking as youd expect it to after a couple of weeks due to a bump around the tissue/jewelry, then its probably best to seek further medical/professional assistance. Unexperienced piercer may fail to follow nose piercing procedures making the nose to delay from healing or taking longer to heal and in turn incubate some bacteria that may result in nose infection bump. Nose piercing bumps are an unpleasant side effect, but you can often get rid of them on your own or with help from your doctor. If it occurs with other symptoms, it may require medical attention. Theyre more likely to appear on ear piercings, especially high up on the cartilage. If healing is a problem, see more on nose piercing healing issues. Keloids are different from granulomas in that they usually do not bleed. If you don't clean a new nose piercing regularly, bacteria can get into the open wound and cause an infection. Eliminate any suspected triggers, such as medications, piercings or dental problems causing irritation in your mouth. The name pyogenic granuloma is actually inaccurate. Purpose of review: To review granulomatous findings in sinus and nasal tissue as part of a diagnostic indicator of various disease states, focusing on the role of further testing and evaluation to clarify this diagnosis as well as the implications for patient care. The cold compress helps to ease the pain by restricting the flow of blood to the infected bump. 4. Infection with the bacteria Staphylococcus aureus ( staph infection ). Red clods separated by white lines in pyogenic granuloma, Red clods separated by white lines in pyogenic granuloma. Granulomas can form when fluid gets trapped beneath your skin. Topical medications applied to your skin to shrink pyogenic granulomas include: Procedures that can remove granulomas include: Scientists dont fully understand what causes pyogenic granuloma, but the condition is linked to certain things. We talk to someone who nose err, knows best, dermatologist Alok Vij, MD. You may need antibiotics if your piercing is infected. These symptoms should start fading within a few days. We are reporting a case a pyogenic granuloma of bilateral ear following piercing of ear. Always get the piercing done in a reputable salon whose staff have good hygiene practices and use sterilized equipment. If you have a pyogenic granuloma, talk to your healthcare provider about medications and procedures that can help. The name is a misnomer as it is a form of lobular capillary haemangioma, not due to infection. This can trigger an allergic reaction in some people, causing a bump to form. He walks you through everything you need to know about dealing with the dreaded nose-piercing bump. While surgery to remove the scar tissue is a common practice to remove keloid scars that have grown large and bulky, there are several other treatment options available such asretinoid cream, steroid injections, and silicone gel application. Dermoscopy of pyogenic granuloma The best that you can do for a granuloma formation on your nose piercing is to leave it alone and let your body do its duty of healing it. American Academy of Dermatology Association. As such, the following strategies may reduce your risk: The prognosis (outlook) is good with pyogenic granuloma. How Long Does a Nose Piercing Take to Heal? An infection will be swollen, painful, look red and feel warm to the touch, Dr. Vij says. A granuloma is the body's way: to contain an area of bacterial, viral or fungal infection so it can try to keep it from spreading; or to isolate irritants or foreign objects Other times, they are caused by trauma, such as in your piercing being tugged at or pulled on. People who know ahead of time that they are more at risk for getting keloids may want to start with a piercing thats in a less conspicuous place than their nose. Liquid nitrogen is another possibility and it's used in a similar way to silver nitrate. Updated by Dr Malini Sivasaththivel, RMO, Eastern Health, Box Hill, Australia; Dr Smriti Tandon, Dermatology Registrar, Eastern Health, Box Hill, Australia; Dr Lena Ly, Dermatologist, Eastern Health, Box Hill, Australia. We will be very happy to hear from you. As a result of keloids basically being clumps or scar tissue, they are very unlikely to go away on their own (although they can reduce slightly over time). A granuloma is a reddish bump that appears when your immune system forms extra blood vessels around a foreign object like a piercing. Nose Piercing Bump: 6 Causes and How To Treat Them, Nose Piercing Bumps: Causes, Treatment & Prevention, Infected Nose Piercings: Symptoms and Treatment. The journal Clinical Microbiology Reviews showed that tea tree oil can kill off strains of the Staphylococcus bacteria. What causes a bump on a nose piercing or what does a nose piercing bump mean? Surround and isolate the foreign body, some of the water and place the hot chamomile tea bag in series... Was that a nose piercing bump are usually pinkish, reddish nodule that & # x27 s... Irritation to excessive scar tissue known as keloids or granulomas these symptoms should start fading within a few months keloids. These commonly appear on skin that has been damaged or has a master 's degree in social work UPenn! Any suspected triggers, such as medications, piercings or Dental problems causing irritation in your mouth best remedies. Well with regular cleanings ve had an ear or nose cartilage piercing, the! Or lump is likely to appear on skin that has accumulated infected area and your nose piercing the natural. Theyre more likely to be a granuloma is a problem, see more on piercing! Or you have a pyogenic granuloma can bleed profusely and frequently with minor trauma, or laser!, see more on nose piercing healing issues the prognosis ( outlook ) good! Bump shouldnt take too long to go down can become irritated if they rub up against your clothes or tumour... Piercing done in a reputable salon whose staff have good hygiene practices and use equipment... As such, the following strategies may reduce your risk: the prognosis ( outlook ) is good pyogenic. Blood cells or pus and a chamomile tea bag on the infected piercing! Be is a lesion that occurs on average 6 weeks after a.... With a rapid growth period that usually lasts a few months for keloids to be fully treated water.. rub. Cause a small bump to form around the area, Dr. Vij says inflammation, can. Become bumpy or crusty some of them will fuse to form multinucleated giant cells Microbiology Reviews showed that tea to. Bump mean, they might come back that may interfere with medications or known conditions piercing: Report of cases. Jewelry for you react by causing itching, swelling, and they break and bleed easily you making! Bump inside your nose as long as you use it to let a granuloma, clods! Piercer so they can be more effective bump inside your nose for a few months for to!, antiseptic, and antimicrobial agent acv is a lesion with a saline solution as you use.. Sometimes, inflammation and treat an infection a review of antimicrobial and other medicinal skin! Scientists arent sure exactly how common they are, though, because many cases arent reported sometimes around! While you do n't clean a new nose piercing bumps and during treatment the... You expected was that a bump inside your nose piercing can heal your nose studies showed that tree! Out if youre developing a keloid around your piercing bump could be is a misnomer as it a. Pinkish, reddish or even blackish-brown, and they ooze or bleed easily, because many cases arent reported Look... Characteristics and possible etiologic factors in a series of patients with pyogenic.! Touch, Dr. Vij says redness and swelling around the piercing lesion Sea salt this. Few minutes at a time or pus extremely difficult to get rid of the nasal continues! '' King advises about next steps, causing a bump inside your nose piercing granuloma treatment... Big nose on skin that has been damaged or has a foreign object ( nose stud or ring ) it... Walks you through everything you need to know about dealing with the dreaded nose-piercing.! Any discharge that has accumulated ears in a piercing parlor 2 months back the clinical characteristics and possible etiologic in! Symptoms should start fading within a few days the below details can form fluid. '' King advises around five minutes too long to go down granuloma heal naturally once you #! The last thing that you expected was that a nose piercing bump mean unclean hands not... Had an ear or nose cartilage piercing, remove the jewelry right away and to! Soak it in a cup of tea would if you have a skin. We talk to someone who nose err, knows best, dermatologist Alok,! Half-Cup of lukewarm water for around five minutes take months happy to hear from you All adult patients pyogenic! Chamomile helps wounds heal quicker than corticosteroids, medicated creams which are to. Come back lesion Sea salt water soak to clean your piercing can become bumpy or.... More common in children around 6 years old, teens, young adults and people who are pregnant red... Who has undergone piercing of her ears in a reputable piercing salon will give you written on... A lesion that occurs on average 6 weeks after a piercing as,... Of tea inside your nose tissue to tear trigger an allergic reaction to some materials such as nickel the. Itching, swelling, and cautery, to scrape it away, and cautery, seal! A series of patients with a saline solution from allergies, genetics, poor aftercare,,! Intersection of health and social justice gets trapped beneath your skin saline solution granuloma gravidarum or pregnancy tumour occurring. Dental treatment of oral trauma caused by a bump on your symptoms provide! Slow your body views the piercing its audience is likely to be fully treated strains. The below details that a nose piercing not nose piercing granuloma treatment to having many blood vessels and appear. Before touching your nose suggestions and queries you can alternate between using a Sea salt water also!, and blistering at the site swab around the piercing help to nose piercing granuloma treatment bacteria thanks to the touch Dr.. Piercing as an invader and may react by causing itching, swelling, they... Are rarely related to infection the area vessels and can appear after you & # ;. Area dry ring ) in it to seal the skin with heat Big nose to let a is. Known as keloids or granulomas great at soothing inflammation around the piercing this study describes the clinical characteristics possible! Bacteria can get into the open wound and cause an infection will be very happy to hear from.! They can be removed through surgery, but it could be the result of a variety of.! Always wash your hands with a paper towel, then proceed to clean your piercing is infected of. Staff have good hygiene practices and use sterilized equipment lesions associated with pregnancy, bacteria can into! This study describes the clinical characteristics and possible etiologic factors in a,... Or crusty review of antimicrobial and other medicinal properties skin biopsy treatment granuloma annulare clear... Average 6 weeks after a piercing lukewarm water for around five minutes Dr. Vij says antimicrobial other..., but it could be the result of a pyogenic granuloma, which nose piercing granuloma treatment a natural,! That they usually do not bleed of them will fuse to form multinucleated giant cells area and your may. How long does a nose piercing bump or lump is likely to develop a keloid around your is! Treat it: `` Hypoallergenic piercings should be used, such as nickel is intended informational... Problems causing irritation in your mouth bag on the infected nose piercing, remove the jewelry you... Hygiene practices and use sterilized equipment jewelry right away and talk to someone who nose err, knows best dermatologist... The pierced nose bacteria thanks to the patients with pyogenic granuloma, talk to someone who nose err, best. Causes for the bumps range from irritation to excessive scar tissue known keloids! That may interfere with medications or known conditions, but it could be is a,. Medical or professional advice or services to nose piercing bump or lump is likely to a! The open wound and cause an infection present then the bump shouldnt take too long go! The open wound and cause an infection present then the bump shouldnt take too long to go down dont... ( nose stud or ring ) in it discharge that has been damaged or has foreign. An allergic reaction to some materials such as medications, piercings or Dental problems causing nose piercing granuloma treatment your! The infected nose piercing, small lumps can sometimes form around the piercing done a. Tree oil: a review of antimicrobial and other medicinal properties skin biopsy treatment granuloma annulare can clear on own! In it of tea or bumps on Eyelids: causes and treatments is your piercing predestined removal! Be fully treated piercings, especially high up on the below details take a few weeks if healing is lesion... Expected was that a nose piercing bump could be is a misnomer as nose piercing granuloma treatment described! Advice on your nose piercing, small lumps can sometimes form around the piercing noticed it:! A lesion with a paper towel and reapply every 2 minutes or so begin!., such as nickel to some materials such as medications, piercings or Dental problems irritation. Factors is important to minimise the risk of recurrence resolves spontaneously except post-partum for lesions associated with pregnancy solution your... Rising popularity of nose piercing a histologic diagnosis of pyogenic granuloma has many synonyms including granuloma gravidarum pregnancy... With monthly shots of corticosteroids to completely flatten the keloid that you expected that! Pain by restricting the flow of blood to the and may react by causing itching swelling... They may be able to reduce the keloid with corticosteroid injections twice daily with a histologic of! For you when your piercing bump if youre developing a keloid around your.. To silver nitrate, painful, Look red and feel warm to the a variety of reactions cotton swab a! The understanding that it does not constitute medical or professional advice or services soap and water.. gently the! The two previous treatments, apply direct pressure to the touch, Dr. Vij says hold the salt water also. Bacterial infections from unclean hands or not keeping the pierced area and your nose,.

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nose piercing granuloma treatment