A Case of a Traumatized Facial Lesion Evolving into an Inflamed Nodule

Case at a Glance

A 23-year-old female presented with a large, indurated, and erythematous nodule on her jawline. The lesion developed over two weeks following repeated and aggressive manual manipulation of what was initially perceived as a small pimple.

Patient's Story

The patient is a 23-year-old female with a medical history significant for daily use of dexamphetamine. Approximately two weeks prior to presentation, she noticed a small lesion on her jawline, which she identified as a common pimple (acne comedone or papule). She attempted to manually express the contents of the lesion on two separate occasions a few days apart. She describes these attempts as forceful and unsuccessful.

Initial Assessment

Following the failed extraction attempts, the lesion did not resolve. Instead, over a two-week period, it progressively enlarged and became more inflamed. At the time of reporting, the patient described a large, firm, and tender lump on her jaw. The lesion was visibly red and painful to the touch. The patient scheduled a physician's appointment for evaluation.

The Diagnostic Journey

The patient's history of a pre-existing small lesion, combined with significant physical trauma from attempts at popping, pointed towards a severe inflammatory response. The primary differential diagnoses included a severely inflamed acne nodule or cyst, a furuncle (boil), or a sterile abscess. The possibility of secondary bacterial infection (cellulitis) was also considered, given the manipulation and resulting inflammation.

Final Diagnosis

Probable Inflamed Acne Nodule or Cyst. This diagnosis is based on the clinical history of a lesion evolving after trauma in a typical acne-prone area. A definitive diagnosis would be made upon physical examination by a physician.

Treatment Plan

While awaiting her appointment, a medical opinion suggested a probable course of action. The standard of care for such a lesion would likely involve interventions to rapidly reduce inflammation and prevent scarring. Recommended treatments included:

1. Intralesional Corticosteroid Injection: To be administered by a physician to directly target the inflammation and reduce the size and tenderness of the nodule.
2. Oral Antibiotics: A course of antibiotics with anti-inflammatory properties, such as a tetracycline (e.g., doxycycline), would likely be prescribed to manage the inflammatory cascade and treat any potential underlying bacterial component.
3. Patient Education: The patient would be counseled to cease all further manipulation of the lesion to prevent further trauma, potential for scarring, and worsening of the inflammation.

Outcome and Follow-up

The patient attended her medical appointment where the diagnosis of a severely inflamed acne nodule was confirmed. She was treated with an intralesional corticosteroid injection and prescribed a course of oral doxycycline. The patient reported a significant reduction in pain, size, and redness within 48 hours of treatment. A follow-up appointment was scheduled to ensure complete resolution and to discuss a long-term skincare regimen to manage her acne and prevent future occurrences.