Salt as a Simple, Cost-Effective Treatment for Drug-Induced periungual pyogenic granulomas

Background: Pyogenic Granuloma (PG) is a benign, vascular lesion seen as a side effect of systemic therapies for melanoma like dabrafenib and trametinib.It is also a common side effect of other targeted therapies.Current treatment options for PG include topical steroids, cryotherapy, silver nitrate, and topical beta-blockers however PG is commonly resistant to these treatments.Other modalities like laser or partial nail avulsion may not be available in all treatment centres.Salt has emerged as a costeffective option to manage periungual granulomas due to its antimicrobial effects.Previous case reports have supported its efficacy and quick effect.We report two of our patients treated with salt, with a good response but onycholysis was observed as the primary early complication.Methods: Retrospective review of 2 cases with periungual paronychia treated with salt.Patient 1 received dabrafenib and trametinib, and Patient 2 received abivantinib; both subsequently developed PG.Both patients were initially treated with once daily application of clobetasol propionate, timolol, an iodine-based dressing along with vinegar soaks.This treatment regime was stopped due to lack of response and the use of salt was trialled.The technique included the application of a layer of petroleum jelly to protect the surrounding skin, a layer of salt to the PG and covered with an adhesive absorbent dressing with the instruction of changing this once daily.This technique was performed daily for three days.