Can shingles occur in the buttock area?

Shingles Can Occur on the Buttocks

Yes, shingles (herpes zoster) absolutely can occur on the buttock area, as this region is innervated by sacral dermatomes where the varicella-zoster virus can reactivate from dormant ganglia. 1, 2

Anatomical Distribution

Shingles follows dermatomal patterns based on the affected nerve ganglia:

• Sacral and lumbar ganglia involvement commonly produces lesions on the buttocks, perineum, and upper thighs 3, 2
• The most frequently involved ganglia are lumbar, thoracic, and sacral posterior root ganglia, followed by the geniculate ganglion and trigeminal ganglion 3
• Buttock involvement is specifically recognized as a presentation site in both males and females according to international diagnostic guidelines 4

Clinical Presentation in the Buttock Region

The characteristic features include:

• Initial symptoms: Pain or discomfort in the affected dermatome before any visible rash appears 3
• Rash evolution: Local edema and erythema develop first, followed by maculopapular lesions that progress to vesicles containing clear viral fluid, which eventually crust over 1, 3
• Unilateral distribution: Typically appears as a single stripe following the dermatome, though immunocompromised patients may have two or more dermatomes involved 3
• The vesicles burst to form shallow ulcers or erosions that heal without scarring 1

Critical Diagnostic Considerations

A common pitfall is misdiagnosing buttock shingles as genital herpes simplex virus (HSV) infection, which can lead to inappropriate treatment and unnecessary psychological distress 1:

• Both conditions can present with vesicular and ulcerative lesions on the buttocks 4
• Laboratory confirmation should always be sought rather than relying on clinical appearance alone, as differentiation can be difficult 1, 5
• Collection of vesicular fluid for viral testing provides definitive diagnosis 4, 1

Special Clinical Scenarios

Sacral Shingles in Women

• Sacral dermatome involvement can cause vulvar pain and dysesthesia that may persist as postherpetic neuralgia 2
• This presentation affects approximately 1.5 million American women during their lifetime, with about 150,000 developing chronic postherpetic neuralgia 2
• Shingles must be included in the differential diagnosis of vulvar rashes and unexplained vulvar pain 2

Immunocompromised Patients

• More severe disease lasting up to two weeks with numerous lesions, often with hemorrhagic base 3
• Higher risk for cutaneous dissemination and visceral involvement including pneumonia, encephalitis, and hepatitis 3
• HIV-infected patients may experience involvement of two or more dermatomes with recurrences 3

Timing and Complications

• Postherpetic neuralgia is the most common complication, potentially lasting weeks to over a year 3
• Prompt diagnosis and treatment can minimize pain severity and duration 2
• The condition is caused by reactivation of latent varicella-zoster virus due to declining cell-mediated immunity, often triggered by old age, stress, steroid use, or malignancies 3