Swollen and Painful Lymph Nodes: When to Seek Medical Attention

Axillary lymphadenopathy with pain and bleeding?

Hello, Doctor: This week, I have been experiencing unexplained swelling and pain in my left armpit.
Initially, there was no discoloration, but it was painful to the touch and felt soft.
The pain has affected my sleep, as I wake up whenever my armpit is slightly compressed.
After a day or two, it became slightly larger and redder, and the day before yesterday, the skin broke.
I have not had any injuries or bruises on my body in the past few weeks.
Yesterday, I applied Clingene-T Gel to my armpit; although there was no injury, it was very painful to apply.
The swelling did not change much the next day, but the pain while walking decreased significantly.
Later that evening, I noticed a little bleeding from my armpit.
I had not touched the swelling at all from the time it swelled until it bled.
Since it was bleeding, I tried to gently squeeze it from both sides, and unexpectedly, brownish blood with a white tint came out.
Since high school, I have occasionally had small, firm, skin-colored lumps in my neck and left armpit (never on the right side).
They are not painful and usually shrink and disappear after a few days.
However, this is the first time I have encountered a lump that is large, red, and painful.
Should I see a doctor? My skin tends to be oily and I sweat easily, especially in my armpits.
I also have red acne scars on my chest and back.
Should I be checked for the possibility of lymphoma? There is no family history of lymphoma.

Wenwen, 20~29 year old female. Ask Date: 2022/09/10

Dr. Chen Sirong reply Oncology

Wenwen / 21 years old / Male
1.
This is my first time experiencing a large, red, swollen, and painful area.
Should I see a doctor?
A: 1.1 Redness, swelling, heat, and pain are symptoms of inflammation.
A physician can evaluate your condition and determine whether antibiotics, pain relievers, or other treatments are necessary to help you recover quickly.

1.2 As for what might be inflamed, it could potentially be lymph nodes.
However, based on your description (I have oily skin that tends to sweat easily, especially under my arms, and I have red acne scars on my chest and back), it is very likely that you have blocked sweat glands that are inflamed.
A definitive diagnosis cannot be made online; you need to see a doctor for proper evaluation.
For reference: In Taiwanese, this condition is referred to as "shēng dāng zǐ" (boil-like folliculitis), also known as "jiāo" or "yōng," which is a type of acne indicating a skin follicle infection and inflammation.
The main causes are skin abrasions and bacterial infections of the pores, with Staphylococcus aureus being the most common culprit.
This can occur in any area of the skin with pores, but is more common in warm, humid, and friction-prone areas.
2.
Should I check for the possibility of lymphoma? My family does not have a history of lymphoma.

A: If you do not feel any other lumps throughout your body, there is no need to seek out testing.
If the lump has been stable for many years, there is no need for special examination unless you experience the following changes:
2.1 Newly discovered lumps
2.2 Existing lumps that have changed
2.2.1 Increased in size
2.2.2 Became hard
2.2.3 Changed color
Wishing you peace and health,
Taoyuan Hospital,
Dr.
Chen Sih-Rong

Reply Date: 2022/09/10

More Info

When it comes to swollen and painful lymph nodes, particularly in the context of your recent experience with a painful lump in your left armpit, it is essential to understand the potential causes and when to seek medical attention. Lymph nodes are an integral part of the immune system, and they can become swollen for various reasons, including infections, inflammatory conditions, or malignancies.

Based on your description, the initial presentation of a soft, painful lump that has since become larger, red, and has even broken the skin is concerning. The fact that it has affected your sleep and has changed in size and color indicates that it may be more than just a benign lymph node reaction. The presence of blood and the change in the characteristics of the lump further complicate the situation.

When to Seek Medical Attention
1. Persistent Symptoms: If the swelling and pain persist for more than a week, or if they worsen, it is advisable to seek medical attention. Lymph nodes that remain swollen for an extended period, especially if they are painful, should be evaluated by a healthcare professional.

2. Changes in Appearance: Any changes in the color, size, or texture of the lymph node, especially if it becomes red, warm, or starts to drain fluid, warrant a medical evaluation. The fact that your lymph node has broken the skin and is bleeding is particularly concerning and should be addressed promptly.

3. Systemic Symptoms: If you experience additional symptoms such as fever, night sweats, unexplained weight loss, or fatigue, these could indicate a more serious underlying condition, and you should seek medical care immediately.

4. History of Lumps: Since you have a history of small, painless lumps that resolve on their own, it is essential to differentiate between these benign occurrences and the current painful, swollen lymph node. The change in your lymph node's behavior is significant and should not be ignored.

Possible Causes
- Infections: The most common cause of swollen lymph nodes is infection, which can be viral (like the flu) or bacterial (such as an abscess). Given that your lymph node has become painful and has shown signs of infection (redness, drainage), this is a likely cause.

- Inflammatory Conditions: Conditions such as autoimmune diseases can also cause lymphadenopathy (swollen lymph nodes).
- Malignancies: While less common, swollen lymph nodes can be a sign of lymphatic cancers, such as lymphoma, or metastasis from other cancers. However, the absence of a family history of lymphatic cancer and your age may lower this risk.

Next Steps
Given the symptoms you have described, it is highly recommended that you see a healthcare provider as soon as possible. They may perform a physical examination, order imaging studies (like an ultrasound), or even a biopsy if necessary to determine the cause of the swelling and pain.
In the meantime, avoid manipulating the swollen lymph node, as this could exacerbate any underlying infection or inflammation. Keep the area clean and monitor for any changes in symptoms.
In conclusion, while many cases of swollen lymph nodes are benign and self-limiting, your current symptoms suggest that a medical evaluation is warranted to rule out any serious conditions and to provide appropriate treatment. Your health and peace of mind are paramount, so do not hesitate to seek help.

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