Treatment for Fungal Infection in the Buttocks Area
For fungal infections of the buttocks, start with topical antifungal therapy as first-line treatment, using either terbinafine 1% cream once daily for 1-2 weeks or an azole cream (clotrimazole or miconazole) twice daily for 2-4 weeks. 1, 2
Determining the Type of Infection
The buttocks can be affected by two main types of fungal infections:
- Tinea corporis (dermatophyte infection): Typically presents as ring-shaped lesions with raised borders and central clearing 3, 4
- Cutaneous candidiasis: More common in skin folds, presents as red, macerated patches with satellite lesions 5, 6
First-Line Topical Treatment
For Tinea Corporis (Dermatophyte Infection)
Terbinafine 1% cream is the preferred first-line agent, applied once daily for 1-2 weeks, with approximately 94% mycological cure rate 1, 2
Alternative topical options include:
- Clotrimazole cream applied twice daily for 2-4 weeks 1
- Miconazole cream applied twice daily for 2-4 weeks 1
- Ketoconazole 2% cream for tinea corporis caused by Trichophyton rubrum, T. mentagrophytes, and Epidermophyton floccosum 6
For Cutaneous Candidiasis
Ketoconazole 2% cream is FDA-approved for cutaneous candidiasis caused by Candida species 6
Alternative azole creams (clotrimazole, miconazole) are equally effective for candidal infections 5, 3
When to Use Oral Antifungal Therapy
Oral therapy is indicated when: 1, 4
- The infection is extensive or covers a large area
- Topical treatment has failed after 2-4 weeks
- The patient is immunocompromised
- The infection is recurrent
Oral Treatment Options
For dermatophyte infections (tinea corporis):
- Terbinafine 250 mg daily for 1-2 weeks is particularly effective against Trichophyton species 1, 7
- Itraconazole 100 mg daily for 15 days achieves 87% mycological cure rate and is effective against both Trichophyton and Microsporum species 1, 7
For candidal infections:
- Fluconazole is first-line for mucosal and cutaneous candidiasis 5
- Itraconazole should be considered first-line for Candida infections, given its shorter treatment duration compared to other options 5
Critical Treatment Principles
Continue treatment for at least one week after clinical clearing to ensure mycological cure, not just symptomatic improvement 2, 4
The definitive endpoint must be mycological cure (negative microscopy and culture), not just clinical response 1, 7
Prevention of Recurrence
To prevent reinfection, implement these measures: 1, 2
- Keep the area completely dry after bathing before dressing
- Avoid skin-to-skin contact with infected individuals
- Do not share towels or personal items
- Wear breathable, loose-fitting clothing
- If concurrent tinea pedis (athlete's foot) is present, treat it simultaneously and put on socks before underwear to prevent contamination of the groin/buttocks area 2
Important Safety Considerations
Baseline liver function tests are recommended before initiating oral terbinafine or itraconazole, especially with pre-existing hepatic abnormalities 1, 7
Itraconazole has significant drug interactions with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 7, 5
Common Pitfalls to Avoid
- Do not stop treatment when symptoms improve clinically – continue until mycological cure is achieved to prevent recurrence 1, 2
- Do not use combination antifungal/steroid creams long-term due to potential for skin atrophy and steroid-associated complications 4
- Screen and treat household contacts if the infection is caused by anthropophilic species, as over 50% of family members may be affected 1, 2