Can impetigo occur on a buttock fold?

Can Impetigo Occur on a Buttock Fold?

Yes, impetigo can absolutely occur on a buttock fold, as bullous impetigo specifically affects intertriginous areas (skin folds), and impetigo can develop on any skin surface, particularly where there is minor trauma, moisture, or maceration. 1

Anatomical Distribution of Impetigo

Nonbullous Impetigo (70% of cases)

• Typically occurs on exposed areas, most frequently the face and extremities 2
• Can develop on any skin surface where minor trauma or breaks in the skin barrier occur 3

Bullous Impetigo (30% of cases)

• More likely to affect intertriginous areas (skin folds), which specifically includes buttock folds 1
• Caused exclusively by toxin-producing strains of Staphylococcus aureus that produce exfoliative toxins 2, 4
• Characterized by fragile, thin-roofed vesicopustules and large, flaccid bullae 2, 4

Risk Factors for Buttock Fold Impetigo

The buttock fold environment creates ideal conditions for impetigo development:

• Warm, humid environments that promote bacterial growth 3
• Macerated or fissured skin in intertriginous spaces 3
• Minor trauma or abrasions that allow bacterial entry 3
• Poor hygiene conditions 3

Treatment Approach for Buttock Fold Impetigo

For Limited Disease

• Topical mupirocin 2% ointment applied three times daily for 5-7 days 5, 2
• Retapamulin 1% ointment applied twice daily for 5 days is an alternative 5

For Extensive Disease

• Oral antibiotics should be used when impetigo is extensive, involves multiple sites, topical therapy is impractical, or treatment with topical antibiotics has failed 5, 2
• For MSSA: dicloxacillin 250 mg four times daily or cephalexin 250-500 mg four times daily for adults 5
• For MRSA: clindamycin 300-450 mg three times daily, trimethoprim-sulfamethoxazole, or doxycycline (not for children under 8 years) 5

Practical Considerations for Buttock Fold Location

• Topical therapy may be impractical in the buttock fold area due to difficulty with application and maintaining contact with the skin 2
• The intertriginous location may warrant consideration of oral antibiotics even for limited disease 1
• Keep lesions covered with clean, dry bandages and maintain good personal hygiene to prevent spread 5, 3

Common Pitfalls

• Do not use penicillin alone, as it lacks adequate coverage against S. aureus 5
• Topical disinfectants are inferior to antibiotics and should not be used 6, 7
• Re-evaluate if no improvement after 48-72 hours of therapy 2, 3
• Obtain cultures if there is treatment failure, MRSA is suspected, or in cases of recurrent infections 5, 2