Moles, Lumps, and Bumps
If you have any mole or growth that concerns you, see your doctor. Do not self-diagnose!
As we get older, a variety of lumps and bumps can make their annoying appearance on our faces. Sometimes moles that were fairly small seem to get bigger and have more hair.
Sometimes we notice the smaller version of the raised brownish spots that we saw on our grandfather’s balding pate. Sometimes acne seems to flare up even well past our adolescence. And sometimes we just notice bumps that mar the texture of the skin on our face.
These lumps and bumps are usually benign growths, each with their different treatments. Only your physician can examine them to know for sure what they are, but this discussion may give you a head start on problems with texture that crop up as we age.
WHAT ARE THE POSSIBLE CAUSES?
WHAT ARE THE POSSIBLE TREATMENTS?
We’re all individuals, so there may be variations in treatment depending on your particular needs and your doctor’s style of practice. Here are some of the most common:
WHAT YOU NEED TO KNOW
Milia (Small, White, Hard Bumps)
"I have small, white, hard bumps on my face that definitely are not acne because they never go away. They last for months or even years. What are these, and how can I get rid of them?"
These are called milia and are a type of very small cyst that hardens under the skin. As you have discovered, they are very difficult to get rid of on your own.
If you try to squeeze or remove these yourself it usually causes so much trauma that your skin looks worse. Your dermatologist can remove these easily with special tools. So if you have more than a few, it makes sense to make an appointment to get them removed professionally.
Sometimes, if they are not too deep, a good aesthetician can steam them and remove them with a small lancit without too much trauma. It may take several appointments to get rid of all of them if they are numerous.
Don’t schedule the appointment for removing these bumps right before an important function or presentation, because you will look a little marked up for approximately three to seven days.
Your dermatologist will probably make a tiny, almost invisible incision over the top of the bump and then use a tool called a comedone extractor to pop the milia out. So there may be a little crusting or blood around the area for a day or two. It then usually heals quite quickly. Occasionally there can be a bruise that may last up to a week or so.
Also, creams in the vitamin A family, like Renova/Retin-A/tretinoin or an alpha hydroxy cream, if used for a month or two before extraction, may help to loosen these a little bit and make them easier to remove. Renova or glycolic acids used over time may also help to prevent them from forming.
If you are someone who is prone to these, you may want to ask your dermatologist about a prescription for Renova (or another product if Renova gives you redness or peeling). Microdermabrasion may also help because it sloughs off dead skin and cleans out the pores.
Learn more about what causes milia.
Enlarged Oil Glands (Sebaceous Hyperplasia)
"I have had oily skin all my life, and now I am noticing that I have very bumpy skin. The bumps don’t seem to be acne because they don’t move around at all, but I am not sure what these are or what to do about them."
From what you are describing, it is very likely that these are enlarged oil glands, also called sebaceous hyperplasia. These show up as very small, soft bumps that are slightly yellowish or off-white in color. It's best to have your dermatologist check to be sure - small skin cancers can sometimes look similar.
Unlike milia, they are not hard, and they tend to be the same texture as skin. Also, if you look very closely in good light, you may see a small pore in the center of each bump. These are basically oil glands that have enlarged over time.
Many of us have one or two on the forehead, chin, or around the nose where most of our oil glands are concentrated. However, if you have very oily skin, together with large pores and acne problems, you may have a lot of the sebaceous hyperplasia. Most people won’t notice if there are just a couple of them, but if you accumulate quite a few, they give the skin a lumpy appearance.
There are a number of different ways to treat these bumps, and your dermatologist may recommend one of these methods. It is not advisable to have these surgically removed and then sutured, because the resulting scars would look worse than the bumps themselves.
Learn more about Enlarged Oil Glands on the Face.
My preferred method of treating enlarged oil glands is with a small electric instrument that looks like a pencil and essentially melts the bumps. This is followed by cleaning out the deep oil pocket. This treatment flattens the bump nicely and does not cause much redness around the bump. It leaves a small crust while it is healing, which takes three to seven days depending on the size of the original spot.
The one disadvantage of this method is that the sebaceous hyperplasia will eventually grow back. But that usually takes anywhere from many months to even years. They can just be flattened again if that happens, and usually the procedure can be done with no scarring at all.
Be aware that most insurance companies will consider this cosmetic - which it is - and won't pay for it. A cost range for doing this is usually in the $250-$750 range depending on how many there are.
Another possibility is to freeze these bumps with liquid nitrogen, either with a swab or with a spray cannister. This also can work but takes longer to heal and causes more redness and irritation around the bumps than with the electrocautery (the electric pen). It also may scar occasionally.
Microdermabrasion does not work for this very well and neither do the lighter peels performed by most aestheticians, such as light glycolic or light salicylic acid peels.
Does it hurt to have these growths removed?
Most of us have had the experience of being in a doctor’s office and having something done to us that we’re not quite ready for. It’s perfectly reasonable to ask your doctor, "Does this hurt?" and "Can any kind of anesthetic be used?" Here is a general description of how some of the procedures described in this article feel.
Liquid nitrogen – a mild to moderately uncomfortable burning sensation – can be quite painful for warts on the palms and soles of the feet. Try taking Tylenol or ibuprofen regularly for 24 hours before being treated. The area treated might be sore for hours to days.
Electrocautery – sometimes also called a hyfercator. It looks like a small electric pen and is used very quickly in a short "zap" that feels hot. Any discomfort is gone very quickly. Usually no discomfort afterwards.
Extraction – done for milia or very deep comedones. Opening up the milia is usually not felt, but if a comedone extractor is used afterwards there is a mildly to moderately uncomfortable pressure sensation that is very short while the extractor presses on the skin for a few seconds. Not uncomfortable afterwards but there may be a temporary small dent in the skin.
Surgical excisions – of moles, and other growths. The only discomfort is from the injected anesthetic. This varies from almost nothing with buffered lidocaine and a skilled nurse to quite uncomfortable (unbuffered lidocaine and less skill). Your pain tolerance is also a factor. After that, there is no discomfort. Ask your dermatologist what to expect post-procedure since this depends on what was done.
"I have dozens of tiny little bumps on my forehead and chin with a few blackheads as well. What are the small bumps and are they part of my acne?"
Yes, these are almost certainly acne from your description; a type called comedonal acne. There are different types of acne and different treatments for the different types. Here's a brief overview here of the type of acne you describe.
One of the most common types of acne, and the one that you describe, is called comedonal acne (the word "comedone" essentially means "plugged pore"). Comedonal acne consists primarily of blackheads (open comedones) and whiteheads that are little flesh colored bumps covered by a thin layer of skin (closed comedones).
Sometimes these tiny closed comedones can occur by the dozens on the forehead, nose, chin, and even sometimes on the cheeks. They have an almost sandpapery texture to them. Comedonal acne is usually not red. If these blackheads and whiteheads turn red (develop inflammation) and form a head, then the comedonal acne is becoming more severe.
Comedonal acne can be very annoying, but it usually responds well to treatment. Prescription acne treatments work well for this type of acne, but other methods, such as light glycolic acid or salicylic acid peels, microdermabrasion, and even facials, can also improve this type of acne.
Microdermabrasion is a method by which very fine crystals are vacuumed across the skin under pressure with a tiny vacuum cleaner-like tip. Some medical-grade devices use a diamond tip that exfoliates the dead skin.
With both types of device, the very fine crystals coupled with the suction take off a layer of dead skin, help to clean out clogged pores, and improve circulation to the skin. Some microdermabrasion is done with a machine that uses a small head with tiny diamond particles, rather than crystals, that do the exfoliation.
Depending on how many comedones you have and how sensitive your skin is, generally five to ten microdermabrasion treatments are done one to two weeks apart. Then a maintenance program to repeat the microdermabrasion every one to three months is usually recommended. For this particular type of acne, which is comedonal, microdermabrasion works nicely.
Light glycolic or salicylic acid peels also help with this type of acne. The low-strength acid is stroked onto the skin and left on for several minutes. The acid then either self-neutralizes or is neutralized by the nurse or aesthetician performing the treatment.
Like microdermabrasion, these light chemical peels also take off a layer of dead skin, help to clean out pores and are used in a series. There are, however, complications occasionally with light chemical peels if the aesthetician or nurse isn’t experienced. This is particularly true for darker skin types. Sometimes the acid can be absorbed more in one spot than another and leave a temporary dark mark. Blisters can occasionally form. Scarring is rare.
If you decide to go this route, try to find a dermatologist-supervised nurse or an aesthetician who is very experienced in performing these peels, particularly if you have darker skin.
Done by an experienced, well-trained aesthetician, facials may also be beneficial. Your face may be steamed and the comedones gently extracted as part of a facial.
I have another article on the site on Acne, with lots of in depth info on acne and its treatment.
See Dr. Irwin's article on Acne In Depth for more information.
"I have several moles on my face that seem to be getting larger and have hair growing out of them. Is it possible to remove these without leaving a big scar?"
It is usually quite easy to remove moles surgically. You will always be trading the mole for a scar, but the question really is, is it a good trade? If the scar is barely visible and the mole is quite raised and noticeable, then it is likely you will think it is a good trade to have it removed. If the mole is tiny, it may not be such a benefit to have it done.
Remember that most insurance companies view cosmetic mole removal as something that is not medically necessary and not covered by insurance. But most dermatologists have a reasonable surgical fee for removal of these benign moles.
There are two ways to remove these moles (nevi). The most common method is to take the mole off flat with the skin after numbing the skin, leaving the base of it in place. Usually that leaves an almost invisible or barely noticeable scar where the mole was. Even if there is a slight color difference between that area and the surrounding skin it can usually easily be covered with makeup.
Healing usually takes one to two weeks, and the area may remain slightly reddish or brownish for several months afterwards. If injuries to your skin usually take a long time to heal completely, it is likely that with a mole removal you may be pink or brownish there for several months. The color, however, will almost always return to normal eventually.
It is important to keep the site moist with an antibiotic ointment or something else that your dermatologist recommends during the healing time. It can also be kept covered with a band-aid if you want. Have the dermatologist who removed the mole instruct you on wound care. Post-procedure infections are very uncommon but can occur.
The disadvantage of removing the mole this way is that it could grow back in the future. Pregnancy, in particular, sometimes stimulates moles to grow. And sometimes moles will grow on their own for no particular reason. If that happens though, the same procedure can just be done again with an excellent cosmetic result.
The only other disadvantage to this method is that hair follicles are not removed. So if the hair growing out of the mole really bothers you, you should consider the second method discussed below. By the way, it is fine to tweeze hair out of moles. It is strictly an old wives' tale that doing so is harmful.
The second method to remove moles is to take a small cookie-cutter like instrument approximately the same size as the mole and remove the entire mole, root and all. The wound is then closed with stitches. The skin is numbed with a small amount of injected lidocaine before the procedure.
The advantage of this is that the entire mole is gone and not likely to recur. In addition, the hair follicles are removed, so if hair is a large part of the problem, you might want to opt for this method.
The disadvantage of this method is that it leaves a more obvious scar. This depends a bit on where the mole is. On some areas of the face it is possible to hide a small scar easily. And there are other areas where it is quite difficult. Your dermatologist can advise you on what would be the best option for your particular mole or moles. Most of the time, you don’t need a plastic surgeon to remove a mole unless it’s in a particularly bad spot.
If you decide to go with this method, the stitches (sutures) usually come out between five to seven days, and the site itself can take weeks to months before it goes back to its natural skin color. Surgical scars can take a full year before they reach their final appearance, but most of the improvement occurs in the first three to six months.
Learn more about removing moles on your face.
Learn more about who needs mole checks.
"Barnacles" (Seborrheic Keratoses)
"I have a number of small, brownish, dry, rough patches on my face and around my hairline. They are raised from the skin a little. What are these, and what can I do about them?"
From your description these are most likely a very common benign growth called seborrheic keratoses. But see your dermatologist because skin cancers can sometimes look similar. Almost everyone over the age of 40 has at least a few of these somewhere. They can occur anywhere on the scalp or face and anywhere on the trunk, arms, or legs. Despite some persistent rumors, there is no evidence that these barnacles are caused by frequent hair coloring.
Seborrheic keratoses are not skin cancers, although if you are not sure what something is, be sure to have it checked by your dermatologist. It is very dangerous to assume that a new growth is not a skin cancer until you have had your dermatologist or primary care physician look at it.
Seborrheic keratoses often have a slightly waxy, warty, raised, or "stuck on" appearance. They often grow slowly, and can get quite large over many years. Seborrheic keratoses can range in color from flesh color to very dark brown or even almost black depending on your underlying skin color. If you have dark hair and dark eyes, the growths are more likely to be a darker brown. If you have light hair and light eyes, the growths are more likely to be flesh colored or a light tan in color.
Since these are benign, cosmetic removal of them is usually not covered by your insurance. Most dermatology offices now have a very reasonable fee schedule to have these removed.
Of the methods to remove these, the most common is liquid nitrogen. The liquid nitrogen is extremely cold and is stored in airtight, insulated cans. It is either sprayed on with a nozzle attached to a small hand-held thermos or applied with a cotton-tipped applicator for a variable amount of time depending on the thickness of the seborrheic keratoses. Even though it’s cold, it feels like a burning sensation. It can be uncomfortable or painful depending on how long the nitrogen needs to be applied to the skin. Afterwards, there may be a burning or throbbing sensation for a few hours or even days.
Take Tylenol or ibuprofen if you are uncomfortable. After the treatment, the site will usually get red and irritated around the base almost like an insect bite and then crust over or even occasionally blister a little bit. The most noticeable crusting or blistering is usually gone in two to four weeks. The site usually heals nicely over time but may leave a temporary mark for several months after removal.
Red Bumps on the Arms and Face
"I have had red, hard bumps on the backs of my arms and sometimes on my face and thighs for many years. My doctor said that this inherited and that there is nothing that will treat this. Is that true?"
The name for this problem is keratosis pilaris. It is a genetic trait, and if you ask any family members, I am sure you will find someone else who has it.
The problem is caused by excess production of a protein called keratin that helps make up the skin cells that line the hair follicles. When keratin accumulates, it causes a plug to form in the hair follicle. The plug irritates the follicle and turns it red.
The reddish bumps appear most commonly on the back of the arms but also on the thighs, and buttocks and other sites. Nothing can change the genetic make-up of your skin or "cure" this problem, but new skin care technology can help improve the problem. Also try wearing looser clothing. The tighter your clothes, the more rubbing there is, and rubbing makes this problem worse. This is why keratosis pilaris usually gets better in the summer.
Topical creams will usually give you a little improvement. Retin-A/Renova and alpha hydroxy acids may help to dissolve the keratin plugs in the hair follicles. This leaves the skin with a smoother and softer appearance. Also mixing those products with over-the-counter hydrocortisone one percent cream will often make it appear less red as well. Try Amlactin cream or Lachydrin cream, which can be purchased at the drug store.
If that doesn’t work, your dermatologist can give you a prescription. Hydrofoam or Keralac are prescribed, and sometimes a dermatologist will specially mix something for you. I’ll sometimes have a compound of salicylic acid, urea, and hydrocortisone mixed at the pharmacy for my patients. There is no true "cure" for this, but it can be made a little softer and less red. Your dermatologist may have some other good special mixtures.
Fibrous Papules of the Nose
"I am 35 and have a new firm bump on the tip of my nose. What is this?"
This is probably a fibrous papule of the nose. These are very common and benign. However, it is important to have this checked by a dermatologist since certain skin cancers can look very similar. If it is a benign fibrous papule of the nose, it can often be removed or flattened by shaving in off or burning it off. The area will be numbed first. Again, your dermatologist can advise you.
If there is any question that it might be a skin cancer, it will be biopsied. This is fine since it both removes the lesion and allows the pathologist to look at the tissue.
SUMMARY OF LUMPS, BUMPS, AND MOLES: WHAT TO DO
There is no one treatment that works for all the lumps and bumps that crop up as we get older. And, in fact, there is no real "high-tech" technique for treating any of these growths, partly because the old standard methods work pretty well.
The best bet is to have your dermatologist look at any suspicious texture problems. You want to be sure that you do not have any skin cancer. Once you have a diagnosis, you can decide what treatment is best for your goals and your pocketbook.
Also, make sure you are protecting your skin as much as possible from the damaging rays of the sun. Here is some great information on sun protection to help prevent skin cancer.
Next, learn about Melasma In Depth.
See Dr. Irwin's expert answers to other reader's questions on moles, lumps and bumps:
Is sunscreen really needed if I'm at home? Problems with pigment increase after peels. Can Thermage, Exilis and Ultherapy be used for prevention? Are Dysport/Botox and Sculptra compatible? A problem! Which retinol is best for use on the delicate eye area? How does radiofrequency (Thermage & Exilis) compare with Ultherapy? All these different forms of Retin A (Renova, Atralin, tretinoin) -- arghhhh!
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