What could be the reason for warmth and soreness on the cheek after pinching the hard bump?

Question

Hi doctor,

I am a 30-year-old male. I am a nonsmoker or drinker of alcohol. I recently noticed one or two hard bumps on my cheek on the left side of my face. I decided to try and pick them, as I thought they were pimples. But there was blood and clear or yellow liquid out and my left cheek has been aching and sore. I do have a beard. I do suffer from psoriasis on the back of my head. I have had a slight toothache on the same side for a while but that comes and goes. I can eat, drink, talk, and swallow. My cheek has felt warm and itchy at times but not constantly. I have made it worse by picking my skin, which is now sore and scabbing over. My known medical conditions are IBS, and vitamin B12 deficiency and I take 50 mg of Sertraline daily.

I will attach a photograph of my cheek.

Answer 1

Hi,

Welcome to icliniq.com.

Please note the following points first:

1) Of the two lesions, both represent some form of psoriasis involving the facial skin at least over the surface. The lower larger ovoid lesion appears to be psoriasis only, although it would be impossible to be sure of that without more images. The upper smaller lesion with a central erosion or ulcer also has surface and peripheral psoriasis. The psoriasis is either evolving or modified with treatment or induced by scratching. Psoriasis lesions are well known to develop at sites of repeated trauma like scratching (called koebner's phenomenon).

2) However there seems to be a deeper cystic lesion beneath the upper scaly plaque. This might represent a developing odontogenic cutaneous fistula. Odontogenic cutaneous fistula appears as a dimpling or a nodule with off or on discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. Its a multidisciplinary management condition. Other possibilities are some other granulomatous lesion beneath the psoriatic lesion, and one must think of the rare possibility of cervicofacial actinomycosis, a chronic slowly evolving infectious lesion.

The off or on toothache is not to be ignored, as tooth involvement is central to odontogenic fistula.