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Pilar cysts on the head - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Skin Hair and Nails
Answered by

General & Family Physician
Practicing since : 2009
Answered : 676 Questions
User :   I have an extremely painful lump above my ear on my head. (left side). The pain is radiating to my scalp and head. I also have lumps at the base of my hairline (left side and painful). Had a brain MRI--negative. I suffer from vertigo attacks, extreme neck stiffness-
Doctor :   Hi
User :   Hi. Good morning.
Doctor :   I am Dr AAAAAAA
User :   Nice to meet you.
Doctor :   Good Morning.
Doctor :   Give me a few seconds to go through your query.
User :   ok
Doctor :   Ok
Doctor :   Is the skin above the lump pinchable ?
User :   no..It is very hard.
Doctor :   Ok
Doctor :   Since how long have you been having this lump ?
User :   Just today, although I frequently get lumps at the base of my hairline.
User :   Actually, I take that back. It comes intermittently.
Doctor :   What is the size of the lump ?
User :   I am trying to figure it out.
User :   Maybe the size of a medium-large marble.
Doctor :   Could you be a little elaborate on that like how many Centimeters long and how much in width ?
User :   I am looking for a tape measure...
Doctor :   Ok
User :   I would say 1 digit of a finger...4 by 4 perhaps
Doctor :   Ok
User :   I am a small female.
Doctor :   May I know your age please ?
User :   36
Doctor :   Do you have any itching or rash or redness on your scalp ?
User :   Not that I know of. However, I did have the shingles last year.
Doctor :   Ok.
Doctor :   Do you see any increased loss of hair ?
User :   My hair is very perhaps,.
Doctor :   Are you on any chronic medication ?
User :   Yes..Wellbutrin, Pristiq, Verapamil (for cluster headaches), yaz, and trazadone
Doctor :   Ok
Doctor :   Now let me put everything in a nutshell,
Doctor :   1. Have a large lump, Hard in consisitency, and 4*4 cms. in length and breadth.
User :   yes'
Doctor :   2. Have small lumps on the left border of your hair line which are multiple in number.
User :   no
Doctor :   Could you elaborate on the smaller lumps that you mentioned ?
User :   Base of hairline. They hurt when touched, and seem to come and go. I was told possible inflamed hair follicles (although they occur frequently)
Doctor :   Ok
User :   There is 1 there now
Doctor :   Ok
Doctor :   Did you consult a Dermatologist for your problem ?
User :   No because I didn't associate it with a possible skin condition.
Doctor :   Ok Let me give you a possible Differential diagnosis : Doctor :   After your symptoms and description ,
Doctor :   1. Pilar cysts would be the first DD most probably.
User :   ok
Doctor :   2. It could also be due to Seborrheic Dermatitis.
Doctor :   3. Sebaceous Cyst
User :   ok..I have heard of them
Doctor :   4. Sebaceous Keratoses
Doctor :   Is there a small punctum out of which a fluid might ooze out on pressure ?
User :   on the neck one
Doctor :   Ok
Doctor :   Is the fluid foul smelling ?
User :   no fluid coming out though
User :   even w/pressure
Doctor :   Ok
Doctor :   I would suggest you to see a Dermatologist who can suggest you the following steps : Doctor :   1. Ultrasound
Doctor :   2. Biopsy of the Swelling.
User :   ok
Doctor :   3. And Surgical excision or medical treatment after diagnosis.
Doctor :   Hope you have followed ?
User :   never thought it could be dermatological...
User :   yes
User :   I appreciate your help.
Doctor :   Hope I have answered your query,
Doctor :   Do you have anything else to ask ?
User :   Yes. Thank you. No..I am good...
Doctor :   Thank you for consulting me.
Doctor :   Take care,
Doctor :   Bye for now
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