Differential Diagnosis
- Single most likely diagnosis
- Furuncle or Carbuncle: The patient's history of a tender lesion in the suprapubic region, which has been present for approximately 7 years with periods of flare-ups, suggests a chronic or recurrent skin infection. The recent increase in discomfort and size, especially after shaving, could indicate a furuncle (boil) or carbuncle, which are collections of pus that form in the skin and subcutaneous tissue, often as a result of Staphylococcus aureus infection.
- Other Likely diagnoses
- Hidradenitis Suppurativa (HS): Given the patient's history of multiple abscesses, including those on the buttocks, and the current lesion's location in the suprapubic region, HS is a plausible diagnosis. HS is a chronic skin condition characterized by recurrent, painful abscesses and nodules in apocrine-gland-bearing areas.
- Pilonidal Cyst: Although less common in the suprapubic region, pilonidal cysts can occur in this area and present with similar symptoms, including a tender nodule or abscess that may drain or become infected.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing Fasciitis: Although rare, necrotizing fasciitis is a life-threatening condition that requires immediate attention. It presents as a rapidly spreading infection of the skin and subcutaneous tissue, often with severe pain out of proportion to the visible signs of infection.
- Cutaneous Malignancy: Certain types of skin cancer, such as squamous cell carcinoma or basal cell carcinoma, can present as non-healing lesions or ulcers. While less likely given the patient's age and history, it is crucial not to miss these diagnoses.
- Rare diagnoses
- Kerion: A severe form of tinea capitis (ringworm of the scalp) that can spread to other parts of the body, including the suprapubic region, and present as a tender, swollen lesion.
- Actinomycosis: A rare bacterial infection that can cause chronic, suppurative lesions, often in the face, neck, or thorax, but can also occur in the abdominal wall or suprapubic region.