The development of periungual pyogenic granulomas while taking the oral acne drug isotretinoin is a known yet uncommon and potentially severe side effect of the oral vitamin A derivative. Previous reports have detailed the development of pyogenic granulomas most commonly arising at sites of previous acne lesions as well as both subungual and periungual locations, with associated paronychia, bleeding, and discomfort. This is thought to arise as a result of the nail bed's fragility and propensity toward spicule formation brought on by the proliferative action of isotretinoin. Here, we report a case of periungual pyogenic granuloma with associated paronychia in a patient taking oral isotretinoin. A review of the pathogenesis and available treatment modalities based on the current literature is provided.
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