What are the treatment recommendations for red, painful circular bumps in the bilateral gluteal (buttock) folds that worsen with heat, humidity, and sweat?

From the Guidelines

For painful red circular bumps in the gluteal folds that worsen with heat, humidity, and sweat, the most likely condition is inverse psoriasis, and treatment should start with a low-potency topical corticosteroid or a vitamin D analog, such as calcipotriene or calcitriol, to minimize the risk of irritation and atrophy 1.

Treatment Approach

The treatment approach for inverse psoriasis in the gluteal folds should prioritize minimizing the risk of irritation and atrophy, given the warm and moist environment of the area.

• Low-potency topical corticosteroids can be used, but with caution to avoid the risk of atrophy and systemic absorption.
• Vitamin D analogs, such as calcipotriene or calcitriol, are effective alternatives with less risk of irritation and can be used in combination with topical corticosteroids to enhance efficacy and reduce the risk of atrophy.
• Calcineurin inhibitors, such as topical tacrolimus, may also be considered for the treatment of inverse psoriasis in sensitive areas like the gluteal folds.

Management Strategies

To manage the condition effectively:

• Gentle cleansing with a mild soap and avoiding harsh products is essential.
• Applying a topical treatment as prescribed, such as a low-potency corticosteroid or a vitamin D analog, to the affected areas.
• Wearing loose, breathable clothing to reduce friction and moisture accumulation.
• Avoiding excessive heat and humidity, which can exacerbate the condition.

Monitoring and Follow-Up

It is crucial to monitor the response to treatment and adjust the therapy as needed to minimize side effects and maximize efficacy.

• Regular follow-up with a healthcare provider is necessary to assess the treatment response and make any necessary adjustments.
• Patients should be educated on the importance of adherence to the treatment plan and the potential risks and benefits of the prescribed therapies 1.

From the Research

Treatment Recommendations for Red Painful Circular Bumps in Bilateral Gluteal Folds

The symptoms described, such as red painful circular bumps in bilateral gluteal folds that worsen with heat, humidity, and sweat, could be indicative of a fungal infection.

• Treatment options for fungal infections include:
  • Antimycotic medications like clotrimazole and fluconazole 2, 3
  • Combination therapy of antimycotics with natural substances like tea tree oil, cannabis oil, and propolis tincture may enhance efficacy 2
• For gluteal tendinopathy, which could be a differential diagnosis, treatment options include:
  • Platelet-rich plasma injections for grades 1 and 2 tendinopathy 4
  • Shockwave therapy, exercise, and corticosteroids may also be effective, although the effect of corticosteroids is short-term 4
• Topical treatments like naftifine, clotrimazole, and hydrocortisone have been studied for their efficacy in treating fungal and inflammatory skin conditions 5, 6
• Emu oil has been compared to clotrimazole and hydrocortisone in the treatment of seborrheic dermatitis, showing potential as a useful agent in improving symptoms, although it may be less effective than conventional treatments 6

Considerations for Treatment

It is essential to consult a healthcare professional for an accurate diagnosis and to determine the most appropriate treatment plan. The effectiveness of various treatments can vary depending on the specific condition, severity, and individual patient factors.