Treating umbilical granulomas

Silver nitrate has been used for a very long time as a simple application which effectively shrinks umbilical granulomas. However it has its problems, such as nasty skin burns if not applied carefully and the need to return for repeat treatments. Topical steroids might be better, and researchers from Denmark investigated this (Brødsgaard A et al. Acta Paed 2015:104;174–7). They recruited 109 infants, and randomised them to three groups: traditional silver nitrate applied in a clinic twice a week; clobetasol propionate cream 0.05% (‘Dermovate’, a potent grade IV steroid), applied twice daily at home by parents; or ethanol wipes only. The two ‘active’ treatments were equally effective: after 30 days, resolution was seen in 29/30 of the silver nitrate group, 27/30 of the steroid group, but only 18/34 of the ethanol wipes ‘controls’ (p<0.0001). Mild excoriation and redness of the skin occurred in 3 of the silver nitrate group, and reversible skin hypopigmentation and atrophy in 6 of the steroid group. As steroid cream can be conveniently applied at home …