By Gary M. White, MD
Acne or folliculitis of the buttocks is not uncommon in adult women. The patient may or may not have acne elsewhere. Long periods of sitting aggravate the condition. Not showering after working out can trigger as well. An occlusive folliculitis may appear similarly or overlap with this condition. Staphylococcal folliculitis is in the differential.
Multiple red follicular papules and pustules scattered on the buttocks may occur in this variant of folliculitis. A bacterial culture should be done to exclude a bacterial folliculitis.
Avoid tight, friction-inducing clothing such as tight jeans and to change out of sweaty gym clothes as soon as possible. Opt for cotton underwear over nylon or Spandex to give the skin a chance to breathe.
Topical benzoyl peroxide is beneficial. One may tell the patient the following:
"At bedtime, two or three times a week, apply a small amount of benzoyl peroxide 5% gel (over-the-counter) to the area, avoiding any 'sensitive' parts; let it dry completely, then wear white underwear (benzoyl peroxide will bleach fabrics). Shower in the morning. If it gets irritating, take a few days off."
One can also prescribe clindamycin topical solution or gel if needed. Aluminum chloride hexahydrate 6.25% (Xerac AC) QHS has been helpful. Rarely, an oral tetracycline antibiotic may be needed.
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