Differential Diagnosis for White Hard Bumps Under the Skin in an 88-Year-Old Male

Single Most Likely Diagnosis

• Sebaceous hyperplasia: This condition is common in elderly individuals and presents as small, hard, white or yellowish bumps under the skin, often on the face. The age of the patient and the description of the bumps make this a likely diagnosis.

Other Likely Diagnoses

• Keratosis pilaris: A condition characterized by small, hard bumps on the skin, often due to keratin buildup. It's common and can appear at any age, including in the elderly.
• Epidermoid cysts: These are small, hard lumps under the skin that can appear anywhere on the body. They are benign but can become inflamed.
• Seborrheic keratoses: Benign growths that are common with aging, appearing as hard, waxy, or stuck-on lesions.

Do Not Miss Diagnoses

• Basal cell carcinoma: Although less likely, any new skin growth, especially in an elderly individual, warrants consideration of skin cancer. Basal cell carcinoma can present as a hard, pearly bump.
• Squamous cell carcinoma: Another form of skin cancer that can appear as a hard, scaly bump, especially in sun-exposed areas.
• Merkel cell carcinoma: A rare but aggressive skin cancer that can present as a firm, painless nodule.

Rare Diagnoses

• Colloid milium: A rare condition characterized by small, yellowish or translucent bumps on the skin, often associated with sun exposure.
• Fibrofolliculoma: A rare benign tumor that can appear as a small, hard bump, often associated with Birt-Hogg-Dubé syndrome.
• Trichoepithelioma: A rare benign tumor of the hair follicle that can appear as a small, hard bump on the skin.

Each of these diagnoses has a different set of implications for treatment and prognosis, emphasizing the importance of a thorough examination and, when necessary, diagnostic testing to determine the cause of the white hard bumps under the skin in an 88-year-old male.