How can I treat this red bump that has been on my back for three years? (Photos)

Question

I have a red bump on my back, behind my shoulder for 3 years. It has white dots on in the center and 3 around the rim . I'm tried tretinoin and chemical exfoliants but it didnt seem to be effective in making it go away. What treatments options are available? I went to a derm and was told to use benzyl hydroxide. Should I have it drained? My camera isn't great so the images weren't clear.

Anna Chacon, MD, FAAD · Answer

Thank you for your question and for providing the photo. Based on the image and your description—a persistent red bump with white dots in the center and around the rim that’s been present for 3 years—this lesion may represent a dermal or epidermal cyst, angioma, or possibly a benign adnexal growth like a dermatofibroma or keloid, especially if there was prior trauma.

The white dots you’re seeing could be comedones or keratin plugs, or small dilated pores. The use of tretinoin and chemical exfoliants likely didn’t help because such treatments are typically more effective for superficial acne or pigmentation issues—not deeper, cystic, or vascular lesions.

Treatment Options:
Observation: If the lesion is not changing, painful, or bleeding, and was diagnosed as benign, it may be monitored without intervention.

Topical Benzoyl Peroxide (BPO): This may help if there's a minor follicular component or if acneiform features are involved—but BPO is unlikely to resolve a long-standing bump that is cystic or vascular.

Intralesional Steroid Injection: If it is a keloid or hypertrophic scar, a steroid injection may reduce its size and redness.

Excision or Biopsy: If the lesion is bothersome cosmetically, symptomatic, or diagnosis remains uncertain, a minor surgical excision or biopsy is the most definitive approach. This will not only remove it but confirm the diagnosis histologically.

Drainage: If this is a cyst and becomes inflamed or infected, incision and drainage may be needed—but this is typically reserved for acute cases, and recurrence is common without full excision.

Given the chronicity (3 years) and lack of response to topical treatments, you may benefit most from in-office evaluation and possible excision. I would not recommend further over-the-counter exfoliants or retinoids at this stage.

Let me know if you’d like help understanding what to ask during a follow-up with your dermatologist.

Glenn Murray, MBBS · Answer

Hi, this photo is blurry. 
If it is a mole it’s Possible to get it surgically removed. Biopsy would also be a smart idea. Have another discussion with your dermatologist/GP.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

How can I treat this red bump that has been on my back for three years? (Photos)

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How can I treat this red bump that has been on my back for three years? (Photos)

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