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swelling under scalp

hi. for the last day or two i have noticed a painless swelling under my scalp. It started around the left temple area last night that was gone when i woke the next morning. I then noticed it had moved to the back of my head near the crown. Today I have gone about normally and when i returned home i realised it is now back by the temple area but now covers a larger area across my forehead too. I have been having a painful or sensitive scalp to the touch for a while, if i rub it it feels very sore just on the top. The swellings as i said dont hurt, and appear quite firm, although the one at the back is much more fluidy. I have been having some mild headaches but other than that I feel quite healthy. I am in India in a fairly remote area so it's not easy to get seen by a good doctor. what would you recommend? Many thanks, *****

Doctor's Response

Date:Sep / 2012

Thank you for your question.

 I am sorry to hear about the problems you are having. Whilst the only realy way to diagnose causes of swellings / skin lesions is to examine them and obtain additional clinical history, I shall explain a few possible causes that may result in the symptoms you describe.

 You describe swellings affecting your scalp as detailed in your question above.

The locations you have found the swellings may suggest inflammatory swellings of lymph glands around the scalp area. The lymph glands located to the back of your head, near the crown; are likely to be "posterior Occipital group of lymph nodes". Another set of lymph nodes is located by the temple area and these may be "pre-auricular lymph nodes" - typically, lymph nodes become enlarged when there is inflammation or infection of the areas they drain (in this case, the scalp ares adjacent to the lymph nodes). Such 'inflammatory' lymph node swellings may well change in size / disappear and reappear depending upon the state and location of inflammation. There can be other causes to explain your scalp swellings including Sebaceous Cysts - these are located in the skin and can become enlarged due to blocked sweat gland ducts or simply collection of sebaceous fluid from inflammation, irritation or other causes.

The fact that you are in India may also suggest such swellings can occur due to insect bites (e.g., in your sleep etc.) and this may well be a local inflammatory reaction. There are other more serious causes of scalp skin swelling or lesions but usually these do not change size and disappear / reappear (they are usually Hard in consistancy and continue to progress).

Treatment may be simple observation to ensure these improve and disappear within a couple of weeks but this depends upon underlying cause (again, actual diagnosis which has to be made by direct examination). I understand your predicament due to location and access issues. However, my professional suggestion would be to seek medical attention if your swellings continue to progress / do not improve or resolve in approximately 2 weeks time.

Mild headahes may or may not be associated with the swellings you describe. You did not say that you had a temperature or sore throat or painful ear or visual symptoms(other causes). Most common cause of headaches are 'Muscle Tension or simple headaches'. I would suggest trying simple Paracetamol 500mg x 2 tablets 3 times a day for a couple of days, or Ibuprofen 200mg 3 times a day for the same period- if headhaches do not resolve or worsen, again you will need to seek medical/ clinical examination and management plan for your conditions.

I hope that I have provided you with some helpful information and would like to wish you good health.

Thank you for using Thanks Doctor. I do hope this information is of use to you.
Yours faithfully,
The Thanks Doctor Team

Patient's Response

Date:Oct / 2012

thanks for your swift reply. Would an insect bite account for the changes in location and size etc? If it is say a lymph node problem is there anything i could do to combat it? Also what is the significance of the sensitive scalp? I've had this symptom a while before this all started happening, it only hurts if i touch it or press the skin. It feels like bad sunburn, but it isnt burnt, and also only on the top of the head. thanks again, *****

Accepted Answer

Date:Sep / 2012

Thank you for your question.

 You are welcome.

Yes, an insect bit can account for the changes in location and size (as inflammatory reaction to a previous bite subsides, and fresh bites in new locations produce swellings).

If the lymph nodes are 'draining' from an inflammed area of Scalp, say, severe dandruff / Seborrhoeic Dermatitis of scalp or an infected bite (lymph glands help our body 'fight' the infection by 'capturing' large cells called macrophages that may have ingested bacteria, hence the swelling which usually slowly settles) - then treating the primary, underlying cause will likely l help resolve the swelling- e.g., Nizoral Shampoo daily to reduce the scalp inflammation and if infected insect bites, some doctors may prescribe an oral antibiotic (after checking allergy hisotry) such as augmentin or Doxycycline to help resolve the skin infection. 

"Sensitive" scalp may suggest scalp inflammation e.g., as in Seborrhoeic Dermatitis or, Eczema affecting scalp - see weblink for further information:

http://www.patient.co.uk/health/Seborrhoeic-Dermatitis-of-Adults.htm

http://www.patient.co.uk/doctor/Seborrhoeic-Dermatitis.htm

The fact that you have had sensitive scalp for a while before 'swellings' appeared does go with above possibility. You did not give any history of using hair dye - this can cause scalp inflammation in some people who are sensitive to the chemicals.

As you are in India, there is always the possibility of Sunburn to the scalp (unless you wear a hat!) - and sunburn of skin (including scalp) can produce local inflammation / swelling - however you are pretty sure this is not a Sunburn so unlikely cause in your case.

Finally, a more rare cause of persistant lymph gland swelling in the head / neck area does include tubercular swellings in the Asian sub-continent but this is less likely given your history (however, if swellings do not improve in the next couple of weeks- please seek medical attention). Best wishes -

Thank you for using Thanks Doctor. I do hope this information is of use to you.
Yours faithfully,
The Thanks Doctor Team

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