The lump on the head hurts when pressed, but no injury

There are many causes for bump on a head beside injury. Some of them are benign but some are severe.

The lump on the head hurts when pressed, but no injury
Viktor Simunović, Dr.med.
Dr.med. Viktor Simunović
20 March 2024.

Various factors, ranging from minor injuries to severe medical conditions, can contribute to the development of painful lumps on the head. While these conditions are typically not severe, they warrant medical attention to prevent infection and to provide appropriate treatment. It's imperative to accurately diagnose the nature of the lump, as treatment approaches vary significantly depending on the underlying cause.

Brain injury

A brain injury resulting from trauma to the head can manifest as a lump and is a condition that necessitates immediate medical evaluation due to its potential severity and complexity. Such injuries may not always be immediately apparent following trauma, making vigilance and prompt action essential.

The presence of a lump, especially when painful upon pressure, could indicate a scalp hematoma—a collection of blood beneath the scalp's skin, often a sign of underlying brain injury.

Ingrown hair

When an ingrown hair develops, it can form a small bump or lump on the scalp's surface, creating discomfort and pain upon contact. In diagnosing such cases, a doctor may examine the affected area to identify the characteristic signs of ingrown hairs, such as redness, inflammation, and a small bump.

Treatment options for ingrown hairs typically involve gentle exfoliation, topical antibiotics if an infection is present, and, in some cases, professional removal of the ingrown hair. Avoiding self-extraction is essential to prevent infection and scarring.

Epidermoid cyst

Epidermoid cysts represent another common cause of lumps on the head that may be painful when pressed. These cysts form when skin cells, which usually shed naturally, instead become trapped beneath the skin's surface, leading to a bump on the head. Unlike pilar cysts, epidermoid cysts are not necessarily linked to the hair follicles but are related to the epidermis layer of the skin.

The lump on your head, characterized by an epidermoid cyst, typically presents as a small, round nodule. It may feel firm and become inflamed or infected, causing discomfort or pain upon pressure.

Pilar cyst

While epidermoid cysts are not associated with hair follicles, pilar cysts, on the other hand, develop directly from them. They represent a distinct type of scalp lump that often causes discomfort when compressed.

They are typically benign and do not attach to the underlying bony structures, differentiating them from more severe conditions. Removal is often sought for cosmetic reasons, as they can be unsightly or uncomfortable.

Giant cell arteritis (GCA)

Giant cell arteritis (GCA), a form of vasculitis, primarily affects the large and medium arteries, especially those in the head, leading to a spectrum of symptoms, including severe headaches and vision problems. This inflammatory condition can cause the arteries to narrow or become blocked entirely, impeding blood flow.

The exact etiology of GCA remains unclear, but it is believed to involve both genetic and environmental factors that trigger an abnormal immune response. Diagnosis typically consists of clinical assessment, elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels, and confirmation through temporal artery biopsy.

Seborrheic keratoses

Seborrheic keratoses represent one of the most common benign skin growths, typically manifesting as wart-like lesions that vary in color from light tan to black. These growths are characterized by their well-demarcated, slightly elevated appearance, often with a waxy or greasy texture. They mainly occur in middle-aged and older adults, though the exact etiology remains predominantly idiopathic.

Despite their benign nature, seborrheic keratoses can become irritated or inflamed when subjected to friction or pressure, potentially causing discomfort when pressed. Histologically, these lesions demonstrate hyperkeratosis, acanthosis, and the presence of keratin-filled cysts known as horn cysts.

While they do not require treatment for medical reasons, symptomatic lesions or those causing cosmetic concerns can be effectively removed through methods such as cryotherapy, curettage, or laser therapy.

Sebaceous cyst

Another common type of benign skin lesion, often confused with seborrheic keratoses, is the sebaceous cyst, which presents distinct clinical and histological characteristics. Arising from the sebaceous glands, these cysts are encapsulated collections of keratin and sebum, often resulting from the obstruction of hair follicles or trauma to the skin.

Clinically, sebaceous cysts manifest as palpable, sometimes tender nodules beneath the skin, often with a central punctum indicative of their origin from a hair follicle. Their size can vary substantially, and while typically asymptomatic, they can become inflamed or infected, leading to pain. Histologically, they are distinguished by their squamous epithelium lining and sebum within the cyst cavity, confirming their differentiation from other cutaneous cysts.

Folliculitis

Folliculitis, an inflammation of the hair follicles, typically emerges as a response to infection, chemical irritation, or physical injury. This condition is characterized by red, inflamed bumps or pimples, often with a central hair, and can manifest anywhere on the skin where hair grows, including the scalp. The etiology of folliculitis is multifaceted, involving bacterial colonization, primarily by Staphylococcus aureus, and non-infectious triggers such as friction from clothing or blockage of the follicle. Diagnosis is mainly clinical but can be supported by microbiological cultures in recurrent or severe cases.

Hives

Hives, medically known as urticaria, manifest as raised, itchy welts on the skin, often resulting from an allergic reaction or other immunological responses. These welts can vary in size and appear anywhere on the body, including the head. The underlying cause of hives is often related to the body's release of histamines in response to an allergen, which dilates blood vessels and fluid leakage into the surrounding tissue, causing the characteristic swellings.

Acute cases of urticaria typically resolve within weeks, though chronic cases can persist longer, necessitating further medical evaluation. Treatment strategies primarily focus on alleviating symptoms through antihistamines and identifying and avoiding triggers.

Basal cell carcinoma

Basal cell carcinoma, the most common form of skin cancer, originates from the basal cells in the epidermis and is frequently characterized by a lump or lesion on the skin that can become painful when pressed. This type of carcinoma typically develops on areas of the skin most exposed to the sun, such as the head and neck. Its growth is generally slow, and it rarely metastasizes or spreads to other parts of the body.

However, if left untreated, basal cell carcinoma can become locally invasive, destroying surrounding tissues and bone. Diagnosis involves a clinical examination followed by a biopsy to confirm the presence of malignant cells.

Lipoma

Often presenting as a soft, moveable lump under the skin, a lipoma is a benign tumor composed of fat tissue. These growths typically develop slowly and are most commonly found in adults between 40 and 60. Though lipomas are generally not cancerous and rarely harmful, their presence can sometimes cause discomfort or pain if they grow and press against nearby nerves or if they are situated in areas where they may be subjected to frequent pressure.

The exact cause of lipoma formation is not entirely understood, but there is a belief that genetics may play a role. Concerning treatment, asymptomatic lipomas often do not require intervention. However, surgical removal may be recommended if a lipoma becomes bothersome or painful.

Hemangioma

A hemangioma is a benign tumor primarily consisting of an abnormal proliferation of blood vessels, which can appear anywhere on the body, often manifesting as a red or purplish lump on the skin. Typically emerging during infancy, these vascular anomalies vary significantly in size and depth. While superficial hemangiomas are noticeable on the skin surface, deeper formations may present as a swelling without the characteristic coloration.

Despite their benign nature, hemangiomas on the head may cause concern due to potential pressure effects on local structures when pressed. The growth phase is usually followed by a spontaneous regression period, where the tumor gradually decreases in size. However, medical evaluation is essential to distinguish hemangiomas from other vascular or neoplastic conditions and to assess the need for intervention.

Fibroma

Fibromas are benign tumors composed of fibrous or connective tissue, which can develop in various body parts, including the head, where they may manifest as palpable lumps. These growths arise from the proliferation of fibroblasts—a type of cell found in connective tissue that plays a critical role in wound healing and tissue repair.

Unlike malignant tumors, fibromas are characterized by their slow growth and localized nature, so they do not typically spread to other body parts. The clinical presentation of a fibroma on the head can vary, but it is often discovered as a firm, non-tender mass under the skin. While fibromas are generally not harmful, their presence can be cosmetically concerning or lead to discomfort if they become compressed or irritated.

Pilomatrixoma

Pilomatrixoma is a benign skin tumor originating from the hair follicle matrix cells. It presents as a hard, painless lump typically found on the head, neck, or upper extremities. This neoplasm arises from the cells that form the hair's structure, leading to a well-circumscribed, calcified mass beneath the skin. It is most commonly observed in children and young adults but can occur at any age.

The diagnosis of pilomatrixoma involves a clinical examination and is confirmed through histopathological analysis, highlighting its calcified structure and ghost cells, a characteristic feature. Treatment primarily consists of surgical excision, ensuring complete removal to prevent recurrence.

Exostosis (bone spur)

Exostosis, commonly referred to as a bone spur, is a benign growth of new bone on top of existing bone, often resulting from chronic irritation or inflammation. Although generally associated with joints and other skeletal structures, this condition can manifest on the skull, leading to palpable lumps that may be painful upon application of pressure.

From a technical perspective, exostosis involves the proliferation of osteoblasts, cells responsible for bone formation, which deposit extra bone tissue. This process is typically a response to mechanical stress or other stimuli that disrupt the average bone remodeling balance, favoring bone formation over resorption. While not malignant, exostosis can cause discomfort and may require medical evaluation to rule out underlying pathological conditions contributing to its development.

Scalp acne

Scalp acne, characterized by the emergence of pustules and inflamed nodules on the scalp, arises from the obstruction and inflammation of hair follicles. This condition is primarily triggered by excess sebum production, which, when combined with dead skin cells, leads to the clogging of follicles.

Subsequently, this environment fosters bacterial growth, particularly that of Propionibacterium acnes, exacerbating the inflammatory response. The clinical manifestation of scalp acne can vary from mild discomfort to severe pain upon palpation, depending on the extent of inflammation and depth of the nodules. Treatment approaches typically involve topical or systemic antibiotics to mitigate bacterial proliferation alongside medicated shampoos containing either salicylic acid or benzoyl peroxide to facilitate the removal of excessive sebum and dead skin cells, thereby preventing further follicular obstruction.

When to see a doctor?

Determining the appropriate time to consult a healthcare professional regarding a lump on the head that causes pain upon pressure is essential for effective diagnosis and management. Individuals should seek medical attention if the lump persists or increases in size over time, exhibits signs of infection such as redness, warmth, or discharge, or is accompanied by persistent pain that does not improve with over-the-counter pain relievers.

Additionally, if the lump appears suddenly following a head injury, even if minor, immediate medical evaluation is warranted to rule out underlying complications.

Furthermore, symptoms such as headaches, visual disturbances, or changes in cognitive function, along with the presence of the lump, necessitate prompt medical assessment to ensure thorough evaluation and appropriate intervention.

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