Managing Hyper granulation with Silver Nitrate: Best Practices in Dermatology

Did you develop a fleshy growth on your wound? If yes, then chances are your wound develops hyper granulation tissue, which is an excessive growth of granulation tissue. This is a sign of a dysfunctional wound environment which can hinder the healing process and increase the risk of infection. However, chemical debridement with silver nitrate can promote healing while lowering the risk of infection. Learn how silver nitrate treatment is effective in managing hyper granulation tissue in this article. If you notice changes in the appearance of your skin, you can consult the best dermatologist in East New York. Please contact Doral Health and Wellness Dermatology Center.


Hyper granulation: causes and effects on wound healing

Hyper granulation occurs due to excessive growth of granulation tissue (an increased cellular density that contains a collection of fibroblasts, macrophages, and new vessels in randomly organized matrix forms at the base of open wounds), a symptom of a dysfunctional wound environment. These can occur in certain areas such as the scalp, temples, and lower legs. Your healthcare providers can identify hyper granulation by its appearance. As healthy granulation tissue appears bright and bubbly red, hyper granulation happens when large lobes of red tissue appear, and coloration varies between bright red to darker shades. These lobes sit above the skin levels. It can be removed for re-epithelialization to occur.

What causes hyper granulation is unknown, however, it is often linked with infection, pressure or friction to the wound bed, negative pressure suction, or a cellular imbalance related to the underlying patient pathology.

As this tissue is typically friable and easily bleeds, when it is located next to a stoma, it causes poor pouch adherence and issues with leaking ostomy appliances. In hard-to-heal wounds, this can proliferate over the wound’s edges, leading to early epithelial edge contact inhibition. This condition prevents edge migration and stagnates or completely stalls wound healing.

That’s why addressing hyper granulation tissue needs to be done while managing any instigating factors like excess moisture with a more absorbent dressing, and bacterial loads to be tampered down with non-cytotoxic antimicrobials. For that, debridement and some dressings are used to address the over-proliferation of tissue.

Management of hyper granulation – chemical methods

Hyper granulation is treated with different debridement techniques, however, chemical debridement using silver nitrate is greatly beneficial because it promotes healing and prevents the risk of infection.

In this procedure, the doctor first removes the dressing to assess the wound site. The wound site is cleaned thoroughly with sterile or distilled water. Then, the doctor applies emollient cream or ointment to surround the skin to protect it, if necessary. They moisten the tip of the silver nitrate with a small amount of sterile water. A moist or bleeding wound is already wet enough to activate the stick. They make sure the tip is not dripping, and carefully apply silver nitrate stick on hyper granulation tissue by using a gentle rolling action. One important thing is to ensure that it doesn’t make contact with healthy surrounding skin because it may cause a slight burning sensation to the patient. After that, they redress the patient’s usual dressing. Keep in mind that hyper granulation tissue will turn grey once treated.

Here are the application tips you should follow while treating with silver nitrate:

  • Make sure the tip of the stick is well covered with silver nitrate powder.
  • If the wound is sufficiently moistened, then use the stick dry, otherwise, moisten the tip of the silver nitrate stick with sterile water.
  • Apply the stick to the area of concern until it is cauterized (turns into a grayish color)
  • If the area is very moist, then you should use more than one stick.
  • The silver nitrate powder may need to be rubbed off while the stick is in the container.
  • Normal saline will decrease or inactivate the effectiveness of the silver nitrate.


Here are the main precautions you should follow while treating with silver nitrate which includes:

  • You need to consult with a clinical nurse consultant before silver nitrate application. They examine and ensure that the area is not suspected to be malignant tissue. If any suspicion is found, then a biopsy should be performed first.
  • Silver nitrate directly lowers fibroblast proliferation, that’s why it’s not recommended for prolonged or excessive use. As a general rule, use silver nitrate only on areas that require treatment and are less than the size of a thumbnail.
  • Don’t use it on infected sites.
  • Avoid silver nitrate contact with healthy tissue, catheter, or tube.
  • If you accidentally touch it or drip it into healthy tissue, flush the area well with normal saline to ensure the caustic action ceases to exist.


Managing hyper granulation with silver nitrate is a good option because it promotes faster healing along with an insignificant risk of infection. Silver nitrate treatment can be given at home as well once you learn all the procedures from the doctor. The usage depends on the severity of the wound. It doesn’t have side effects, but careless handling can cause strains and burns on the skin. That’s why all instructions for silver nitrate usage should be followed properly.


If you need help with a hyper granulation wound, visit our dermatologist in Brooklyn clinic for proper diagnosis and treatment. Call us for a consultation or to book your appointment. At Doral Health and Wellness Dermatology Center, we have the best dermatologists that can help you take care of your skin. As dermatology experts in East New York, we are dedicated to providing the best services. You can visit us at 1797 Pitkin Avenue, Brooklyn, New York to schedule an appointment. You can also call us at 1-347-384-5690 or visit our website at