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Suggest treatment for a lump above the left ear

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Posted on Tue, 19 Jul 2016
Question: Hello,

I came home from dermatology office today after trying to remove what the dr was SURE a pilar cyst. the problem is, this lump on the left side of my head, 1-2 inches above left ear, came on overnight 7 days ago, it is quite tender to touch, within about 12-24 hours of this appearing i developed a severe headache (im a migrain sufferer, and this by far outweighs this, because ZERO relief was achieved, and i had it 24/7. Along with that came this excruciating pain on top of scalp above and around the lump, the pain from just touching a strand of hair made me want to scream and hide! Almost like a sunburn feeling, but zero to see on scalp itself....frustrating! From there, all the joints in my legs became so painful, I couldn't even walk very far. When the dr got in there today, she cut into where the cyst should be found, and nothing there, she went deeper and wider and still no cyst. ( at first she thought the headache and scalp pain could be nerve pain from lump) She ended up a mass of tissue, that really didn't look that "bad", no obvious pus or infection. she took it out to send for biopsy. I researched the Pilar cysts before this appt, and symptoms did not match to me at all. I do have some chronic health issues, Chronic Kidney Disease, as well as UC with some liver dysfunction, and arthritis as well. What should I be thinking about what it might be?
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Answered by Dr. T Chandrakant (16 minutes later)
Brief Answer:
Infected cyst/boil - causes lots of pain in scalp

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Read the history carefully and understood your concerns.

My thoughts:
Since the painful area/lump above the left ear had come overnight 7 days ago, this could have been an infected pillar cyst, scalp is known to have small cysts that can go into infection.
Since the infected cyst loses all the clarity of separation as everything is stuck together, it is very difficult to separate and remove the cyst as can be done in case of non-infected cyst.
Infection causes edema in the surrounding tissues. When there is no place for the edema to disperse it becomes under pressure which in turn increases the sensitivity too much. That might have been the reasons for your severe pain.
You already have multiple medical problems as you have mentioned, must be taking medications and all these do lower the pain tolerance and body resistance too.

I hope this answers your query, please feel free to ask for further relevant queries if you feel that there is a gap of communication.


Above answer was peer-reviewed by : Dr. Sonia Raina
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Follow up: Dr. T Chandrakant (1 hour later)
Thank you very much for your quick and detailed thoughts.

That sounds reasonable enough. Would the dr had seen tissue that looked like an infection though? She really didn't feel that she saw any kind of abcess or anything.

Also the headache, literally no relief 24/7, worst headache I've ever experienced since this lump appeared. There is also a spot above that lump we took out, on top of left scalp, that feels as though there is a very small lump developing, that just started yesterday, and it too is very very tender and painful.

She mentioned some fatty type tissue, but very small amount. Did punch biopsy of area. Just waiting on results, but I just really feel like we are missing something.
doctor
Answered by Dr. T Chandrakant (4 hours later)
Brief Answer:
As discussed in details below.

Detailed Answer:
Thanks for your appreciation and feedback.
Definitely yes, you Doctor must have tried all the best to see the exact things whether abscess or what, but in many cases there may not be an actual abscess and only inflammation.
Well, the biopsy report will help us to know more.
If the surgery is done under local anesthesia, the infiltrated anesthesia also make feeling and visualization difficult.
Headache: I hope MRI of the brain, EEG and Neurologist opinion must have been taken sometimes, please give feedback. And if not done yet, please go for it.
Very small lump can be a boil type thing and being in scalp is very tender and painful.
Please tell me the biopsy reports.


Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Dr. T Chandrakant

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Suggest treatment for a lump above the left ear

Brief Answer: Infected cyst/boil - causes lots of pain in scalp Detailed Answer: Hi. Thanks for your query and an elucidate history. Read the history carefully and understood your concerns. My thoughts: Since the painful area/lump above the left ear had come overnight 7 days ago, this could have been an infected pillar cyst, scalp is known to have small cysts that can go into infection. Since the infected cyst loses all the clarity of separation as everything is stuck together, it is very difficult to separate and remove the cyst as can be done in case of non-infected cyst. Infection causes edema in the surrounding tissues. When there is no place for the edema to disperse it becomes under pressure which in turn increases the sensitivity too much. That might have been the reasons for your severe pain. You already have multiple medical problems as you have mentioned, must be taking medications and all these do lower the pain tolerance and body resistance too. I hope this answers your query, please feel free to ask for further relevant queries if you feel that there is a gap of communication.