Subcutaneous Nodules: Causes and When to See a Dermatologist - Dermatology

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Subcutaneous nodules, such as the one you described on your buttocks, can arise from various causes, and it’s essential to understand their nature to determine the appropriate course of action. Based on your description, the nodule started as a hard lump, possibly resembling a pimple, and has since developed into a painful, red area that has begun to ooze pus mixed with blood. This progression is concerning and warrants further evaluation.


Possible Causes of Subcutaneous Nodules
1. Infection: One of the most common causes of a painful, pus-filled nodule is an infection, such as an abscess. This occurs when bacteria enter the skin, leading to localized inflammation and pus formation. The presence of blood in the pus may indicate a more severe infection or tissue damage.

2. Sebaceous Cyst: These are non-cancerous lumps beneath the skin that can become inflamed or infected. They are typically filled with a thick, oily substance and can become painful if they rupture.

3. Folliculitis: This is an inflammation of the hair follicles, often caused by bacterial or fungal infections. It can lead to red, painful bumps that may ooze pus.

4. Lipoma: A lipoma is a benign tumor made of fat tissue. While they are usually painless and soft, they can sometimes become uncomfortable if they press on surrounding tissues.

5. Dermatological Conditions: Conditions like hidradenitis suppurativa can cause painful nodules and abscesses, particularly in areas where skin rubs together.


When to See a Dermatologist
Given that your nodule has been present for a week, has started to ooze, and is painful, it is advisable to see a dermatologist as soon as possible. Here are some signs that indicate you should seek medical attention:
- Persistent Symptoms: If the nodule does not improve or continues to grow, it’s crucial to have it evaluated.

- Increased Pain or Swelling: If you experience worsening pain or swelling, this could indicate a more serious infection.

- Fever or Systemic Symptoms: If you develop a fever or feel generally unwell, this could suggest that the infection is spreading.

- Changes in Appearance: If the nodule changes in color, size, or consistency, it’s important to have it assessed.


Diagnostic Approach
A dermatologist will likely perform a physical examination and may recommend further tests, such as:
- Ultrasound: To assess the structure of the nodule and determine if it is a cyst, abscess, or something else.

- Culture: If there is drainage, a culture may be taken to identify any infectious organisms.

- Biopsy: In some cases, a small sample of tissue may be taken for analysis to rule out more serious conditions.


Treatment Options
Treatment will depend on the underlying cause of the nodule. If it is an abscess, the dermatologist may need to drain it and prescribe antibiotics. For sebaceous cysts, surgical removal may be recommended if they are recurrent or bothersome.

Conclusion
In summary, while subcutaneous nodules can arise from various benign causes, the symptoms you describe—particularly the presence of pus and blood—suggest that you should seek medical attention promptly. A dermatologist can provide a proper diagnosis and treatment plan tailored to your specific condition. In the meantime, avoid squeezing or manipulating the nodule, as this can exacerbate the situation or lead to further infection.