Hard, White, Tender, Painful, Little Lump on Scalp Under Skin: Causes, Symptoms

A lump on the scalp can pass unnoticed for a long time under the cover of hair. In fact, not many of us know exactly what our scalps look like. You may be surprised to find contours and dimples on your scalp which you never knew were there.

The scalp is not perfectly smooth and round. But that is normal for everyone. Lumps, however, are something different. If you discover a hard mass under the skin of your scalp, it should cause you some concern.

Most lumps that develop on the scalp are not life-threatening. Most can be left untreated or under close monitoring. Some, however, are forms of medical emergencies which require immediate medical attention. The only way you can be certain if a lump on your scalp is harmless or not is by visiting your doctor for a diagnosis.

Common causes of scalp lump under skin

A scalp lump under skin can be caused by any of the following:

Cysts

Cysts are very common causes of lumps under skin. They are benign tumors that are painless in most cases. A good example of a painful cyst is a lump in the palm of the hand below the middle finger caused by giant cell tumor of the tendon sheath.

On the scalp, you can develop a pillar cyst or an epidermoid cyst.

  • Pillar cyst – pillar cysts originate in clogged oil glands or hair follicles. Unlike acne, cystic materials move much deeper into the skin. For this reason, they don’t have visible tops. Large ones may, however, form noticeable bumps. Some pillar cysts are hard but most form soft lumps that are slightly movable. It is possible to have a pillar cyst hard lump on the testicle, vulva and basically any part of the skin that has hair follicles.
  • Epidermoid cysts – epidermoid cysts form when epidermal cells move deep into the skin. Naturally, cells of the outer protective layer of skin are consistently shed and replaced. These cells can sometimes move into the skin to form a pouch or a sack known as an epidermoid cyst. Epidermoid cysts mostly form hard lumps due to presence of keratin.

Folliculitis

Folliculitis is inflammation of the hair follicles. Bacterial and fungal infections are the common causes. Other causes include irritation of hair follicles, viral infections and injuries. Folliculitis is characterized by the formation of red, painful little lumps on the scalp around hair follicles. More than one lump can occur. Severe folliculitis causes large, red bumps filled with pus. They occur in a cluster of boils known as carbuncle. Carbuncles are extremely painful and can spread infections or cause a lump in throat thyroid symptoms due to swollen lymph nodes. A large boil is known as an abscess. Boils are different from folliculitis since they form a bit deeper in the skin and are infected with bacteria. A painful lump on the scalp filled with pus can be a boil.

Moles

Moles are benign growths that appear on the surface of the skin. They are quite common. An adult male can have up to 50 moles throughout the body and these mostly form before you are 20 years old. You can have a skin-colored mole or a red-brown one. Since melanoma (type of skin cancer) usually begins with mole-like bumps, you are advised to get medical help if a mole shows the following signs:

  • Gradually increases in size
  • Has a rough top
  • Has irregular edges
  • Keeps changing color
  • Has multiple colors
  • Is not symmetrical

Seborrheic dermatitis

Dermatitis is another name for eczema. This is a common scalp skin condition that causes red patches of irritated skin. If not treated, little fluid-filled blisters form on the patches. With time, the blisters may burst open, leak clear fluid and crust over. Seborrheic dermatitis is also referred to as dandruff and can also occur on eyebrows.

Nevus Sebaceous of Jadahsson

This condition gets its long name from the man who first described it and the fact that it is mostly consisted of sebaceous glands and hair follicles. It is characterized by raised yellow patches on the scalp. Most cases are seen in children but can also develop in adults.

Warts

Warts are viral infections caused by HPV.  Unlike genital warts, HPV on the scalp is mostly transmitted through injuries. These fleshy growths take on the color of skin and tend to form clusters or lumps that resemble cauliflowers. Normally, warts are not painful but can cause pain if bruised, such as when combing your hair.

Injuries and fractures

It is common to develop a bump after an injury or bone fracture. Such bumps disappear or improve after a few days. For serious injuries such as fractured scalp, medical help should be sought. This is because they can lead to blood clots inside the scalp which is potentially very dangerous. A blood clot under the skin is however usually not dangerous. For example, men often discover a painful lump in scrotum after a vasectomy which is just a result of clotted blood. Such lumps resolve on their own.

Benign tumors

Benign tumors such as lipomas (fatty tissue growths) fibromas (connective tissue growths) and lymph nodes can cause lumps or bumps on your scalp under skin.

Cancer

Rarely will a hard lump on the scalp be a cancerous tumor. If so, it can be due to skin cancer or bone cancer. Tumors under the skull, such as brain cancer, do not cause lumps on the scalp. Basal cell carcinoma causes the affected skin portion to appear waxy. Squamous cell carcinoma causes a raised crusty patch on skin that doesn’t disappear or improve. Melanoma causes red, brown or dark lesions on skin that gradually gain mass. See your doctor if you see such symptoms.

Symptoms of lump on scalp

  • Hard, painless, round or oval lumps that feel a bit movable when pressed with a finger. These are cysts.
  • Soft, rubbery and movable lumps under the skin are lipomas.
  • Painful lump on scalp surrounded by red, warm and tender skin signifies folliculitis. If the lump has a white tip and feels soft to the touch, it is a boil.
  • Flesh-colored or red-brown little lumps on scalp are moles. They should not be painful.
  • Fleshy, skin-colored growths that resemble a cauliflower are warts.
  • Red, crusty and inflamed skin patches signify dandruff.
  • Yellow and sometimes purplish or brown raised plaques in a child’s scalp are a sign of Nevus Sebaceous of Jadahsson.
  • A firm, painless lump beneath the skin that is always there is most likely a lymph node.

Diagnosis and treatment for lumps on scalp

Physical exams are the most common methods used for lump on the scalp diagnosis.

Imaging tests such as MRIs and CT scan can be used when a lump occurs beneath the scalp skin or on skull. Infections and cancerous cells are diagnosed with biopsy.

Treatment option to be prescribed will depend on what is causing the lump and the diagnosis reports.

Lipomas, cysts and other benign tumors can be left without treatment. If necessary, tumors are mostly removed surgically. They may also be injected with anti-inflammatory medications or be drained. A cystic painful lump in earlobe for example may require to be shrunk with anti-inflammatory medications before being surgically removed.

Conditions such as folliculitis can be treated with medications used to fight acne. Severe cases may require surgery or laser removal of hair. Medicated shampoos and antibiotics may be prescribed when a lump on the scalp is associated with bacterial infections.

Malignant tumors require a more sophisticated treatment approach. It is for this reason that medical attention should be sought the earliest possible.

When to see a doctor for a lump on scalp

See your doctor if a lump on your scalp:

  • Gradually increases in size
  • Is intolerably painful
  • Causes fever, fatigue and swollen lymph nodes
  • Doesn’t show signs of improvement after 2 weeks
  • Seems to have popped up out of nowhere

Also, see your doctor if you discover lumps elsewhere in your body. For example, a painful lump near esophagus appearing near the same time with one on scalp can be a sign of severe infection or cancer.

When preparing for your appointment, write down a list of the most persistent symptoms you have been having since the lump appeared. The information will greatly help your doctor decide on the most probable cause of the lump. An accurate diagnosis is very important, especially when dealing with signs that could indicate cancer or bacterial infections.

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