Differential Diagnosis for Hard Lumps in Armpits
Single Most Likely Diagnosis
- Hidradenitis Suppurativa (HS) Exacerbation: Given the patient's history of hidradenitis and the presence of hard, sore, itchy, and burning lumps in the armpits bilaterally, an exacerbation of HS is the most likely diagnosis. HS is a chronic skin condition characterized by recurrent, painful abscesses and nodules in apocrine-gland-bearing areas, such as the axillae.
Other Likely Diagnoses
- Folliculitis: An inflammatory process involving the hair follicles, which can present with itchy, sore, and burning lumps, especially in areas like the armpits where friction and moisture are common.
- Furuncles or Carbuncles: These are infections of the hair follicle that can cause painful, swollen lumps. They can occur in the armpits and might be itchy or burning, especially if they become infected.
- Lymphadenitis: Inflammation of the lymph nodes, which can be caused by infection or other inflammatory conditions, leading to sore, swollen lymph nodes in the armpits.
Do Not Miss Diagnoses
- Breast Cancer with Axillary Metastasis: Although less common, hard lumps in the armpits could be a sign of breast cancer that has spread to the axillary lymph nodes. This diagnosis is critical to rule out, especially in patients with risk factors for breast cancer.
- Lymphoma: Certain types of lymphoma can present with lymphadenopathy (enlarged lymph nodes) in the axillae, which might be painful, itchy, or burning.
- Cat-Scratch Disease: Caused by Bartonella henselae, this infection can lead to swollen and painful lymph nodes, often in the axilla if the scratch is on the arm.
Rare Diagnoses
- Granulomatous Lymphadenitis: Conditions like sarcoidosis or tuberculosis can cause granulomatous inflammation of the lymph nodes, leading to hard, sometimes painful lumps in the armpits.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenitis, typically in the neck but can occur in the axillae, presenting with painful lymph nodes and systemic symptoms.
- Silicone Granuloma: In individuals with a history of silicone implant use, a granulomatous reaction can occur, leading to hard lumps in the axillary region due to the body's reaction to the silicone.