Facial Lesion with a hole in the middle

About a month ago my grandmother noticed a large red itchy and sore bump on the side of her face. At first I thought it was an infected insect bite so I took her the doctors where she was given a steroid cream to try and take the swelling down. This did not help, in fact it only seemed to get worse. A week leter I took her back to the doctors because it was beginning to puss and she was given a course of penicillin to fight any infection that there may have been. This again did not help and when we returned to the doctor another course of penicillin was prescribed. We have been back since and the as the doctor has no idea what it is, has referred her to the hospital. This was sufficient until this morning I have been to see my grandmother and the swelling has gone down a bit but the bump is now an irregular shape approx 3cm in length and there is a substantial hole in the middle approx 0.5cm diameter and 0.5cm deep. There is no puss, blood or anything in it. It is very unusual and she says that it is extremely painful and itchy. Do you have any idea what this could be as I am very worried.

[Bhupinder Kaur, MD]

Hello,
It looks like a boil or a carbuncle. Boils are caused by infection of the hair follicle by staph aureus and are very painful unless they drain spontaneously or an incision is given by a doctor. apply warm compresses and Neosporin ointment and avoid messing with it. You can give your grandmother anti-inflammatory pain killers like ibuprofen or acetaminophen.

However she may require oral antibiotics and incision and drainage also.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[maatson]

Could be a 'carbuncle'. Hope she is not a diabetic.

[tricky935]

Thank you so much, I think you may be right. Luckily she is not diabetic.

[Bhupinder Kaur, MD]

Hello,
It looks like a boil or a carbuncle. Boils are caused by infection of the hair follicle by staph aureus and are very painful unless they drain spontaneously or an incision is given by a doctor. apply warm compresses and Neosporin ointment and avoid messing with it. You can give your grandmother anti-inflammatory pain killers like ibuprofen or acetaminophen.

However she may require oral antibiotics and incision and drainage also.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[tricky935]

Many many thanks. My grandmother is going to the dermatologist tomorrow and I am most intrigued as to find out what it is. I shall keep you posted and hopefully it is nothing serious. You have been most helpful and have put my mind at rest and your answer was the most insightful. Thank you again.

[tricky935]

Hello,
I would like to thank you for your answer those months ago but since she has been to the dermatologist and we found out that it was skin cancer. What I did not know was that she has had a cancer removed from her leg before this so the dermatologist was not surprised to find that she had suffered again. It has since been removed and they think that although it grew so very quickly it was not as aggresive (aggressive) as first thought. It has been sent for analysis but I do not know the results of this. The hole in the middle was an infection that had burst and emptied itself.
Thank you for your diagnosis and I know that it can be very difficult to diagnose without seeing it.
Thank you again, Pippa.