A reddened, sore skin on the crack of your buttocks could be a symptom of pilonidal sinus disease (PNS). It’s usually asymptomatic unless a cyst or an abscess forms over the sinuses in your butt crack. If the sore skin area appears raw and inflamed with small itchy lumps, it must be a skin rash or an intertrigo. Keeping the area clean and dry and applying zinc oxide ointment may help with the skin rash. Plucking out any unwanted hair on your butt crack may also help with minor cases of pilonidal sinus disease. For instances of severe infection, you may need to take antibiotics along with other medical procedures done at the hospital.
Pilonidal sinus occurs when a small hole or clusters of tunnel-like holes develops on the skin on your natal cleft, commonly known as the buttcrack. It may look like a small, dimple-like depression on the surface of your skin, making it hard to detect at first.
Now, these little buggers may seem harmless, but they’re going to make you suffer from pain. So, it’s best if you could detect a pilonidal sinus disease much earlier before it grows or becomes infected.
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What causes a pilonidal sinus?
Doctors believe that when the pores in the surface of your buttcrack stretch out, like when you’re sitting down, dead skin cells, hair, and other debris may form a clog.
Thus, when your body produces its natural oils (sebum), it gets trapped and builds up in your follicle, causing it to stretch. Eventually, it may rupture inside, resulting in an inflammatory response that forms the pits or cluster of sinuses in your butt crack.
Pits or sinuses are actually “the worst.”
It means that if you have them, you can expect to experience pain and suffering onwards. Well, these pits make way for bacteria to enter your skin tissues. Another inflammatory response-yikes!
But wait till it forms into a cyst or worse, abscess– the foul-smelling leakage or collection of pus. It’s the last thing you want to deal with on your skin!
Risk factors of pilonidal sinus
Anybody can get a pilonidal sinus or cyst disease. But, you’re more susceptible to the condition if you have:
- Family history of pilonidal disease
- Traumatic injury to the tailbone
- A lot of body hair in the intergluteal cleft or butt crack
- Thick and coarse body hair
- Spend a lot of time in a sitting position (office workers or truck drivers)
- A dimple or pit in the tailbone area during birth
- Fetal spine development problems like spina bifida occulta
- Large size of the pores in the skin over the tailbone
- Habit of sitting improperly (slouching)
- Weak immune system
- Have a condition called hidradenitis suppurativa
- Have acne, boils, sebaceous cysts, or other skin problems such as eczema
- Wear tight clothing that presses or cause friction on the tailbone area
Signs and symptoms of pilonidal sinus disease
Signs of pilonidal sinus disease could be hard to detect at first. You may develop a pilonidal sinus but never feel any symptoms unless a cyst forms or an infection occurs.
You will feel the following symptoms when your pilonidal sinus becomes infected:
- Pain that becomes intense when you are sitting or standing
- Sore and redness around the area of your butt crack or the crease between your buttocks
- Swelling of the area
- Pus oozing and blood draining from the swollen area
- Tenderness of the swollen area when touched (cyst)
- Presence of more than one sinus tract or holes in the butt crack
- Hair protruding from the lesion
- Sometimes fever, nausea, and fatigue
6 tips for treating pilonidal sinus disease
Most people never want to discuss a small fissure or hole present in their butt crack as they find it embarrassing.
You should never ignore it if you have one, even if symptoms don’t occur. As mentioned before, these little buggers may seem harmless, but they’re going to make you suffer from pain.
If you’ve been suffering from sore and reddened skin in your butt crack, these could be signs of early infections. Please, check with your doctor at once.
Treatment for pilonidal sinus disease depends on the severity of your symptoms, the size of the sinus, or if it’s an acute or chronic condition.
To help with small, uninfected pilonidal sinus, always:
- Keep the area clean and dry
- Remove hair on the skin regularly
- Avoiding sitting down for long periods
Your doctor may prescribe you broad-spectrum antibiotics to eliminate a wide range of bacteria and prevent infection.
When a cyst or abscess forms over the sinus, your doctor may recommend one of the following treatments:
Your doctor will have to drain out the contents inside the sinus to alleviate your pain.
You will receive a general or local anesthetic before your doctor performs a cut on the abscess. Then, they will drain the pus and remove any hair and other debris inside it. Lastly, your doctor will pack the wound with sterile gauze to let it heal from the inside out.
It usually takes four weeks before the incision would completely heal.
2. Phenol Injection
Under local anesthesia, your doctor will inject 80% phenol, a chemical compound used as an antiseptic, into the sinus.
It will be left there for a minute and then released using pressure. Your doctor will then remove excess phenol and other debris in the sinus and pack the wound with a gauze pad.
The phenol will allow the lesion to harden and close.
3. Wide excision and open healing
For painful and recurring pilonidal abscesses, your doctor may recommend surgery to remove the sinus altogether.
You will be under general anesthesia when your doctor performs this procedure. They will drain the fluid, and then the sinus will be cut out along with its surrounding skin.
Your doctor will leave the wound open to heal on its own which, can take up to 6 to 12 weeks. Remember to follow your doctor’s instructions on changing the wound dressing daily.
4. Excision and wound closure
This surgery also involves removing the whole sinus while you’re under general anesthesia. When the sinus has been removed, your doctor will cut out an oval-shaped, healthy flap of skin around the area and stitch the two sides together.
It will take up to 10 days before stitches will be removed.
5. Endoscopic ablation
It is a type minimally-invasive medical procedure that effectively treats pilonidal sinus disease.
You will receive a spinal or general anesthetic before the procedure. Then, your doctor will insert an instrument called a fistuloscope into the sinus tract to get a clear view of the affected area.
They will remove hairs, infected tissues, and other debris inside using forceps and clean it with a special solution. Heat is used to seal the sinuses and abscess cavities.
This procedure has high success rates and guarantees a lower risk of infection as it does not involve any large incision.
Your recovery may take up to 4 weeks or less.
6. Other treatments
Some patients may also consider getting plastic surgery to reconstruct the area after completely removing the sinus.
Fibrin glue injection can also be used as a less invasive treatment for pilonidal sinus disease or as an addition to the traditional removal surgery.
Prevention and follow-up care methods
To prevent pilonidal sinus or cyst from recurring, make sure to follow your doctor’s instructions which, may include:
- Wash and clean your butt area with mild soap daily.
- Make sure to keep the area dry.
- Remove hair on your buttocks or butt crack by shaving or using hair removal products effective for ingrown hair every 2 to 3 weeks.
- Wear comfortable, loose-fitting cotton underwear.
- Lose extra weight.
- Avoid doing strenuous activities such as lifting weights for at least a week after surgery.
- Avoid swimming, driving, or riding a bike during your early recovery period.
- Don’t sit in a slouching-sitting position.
- Don’t sit for long periods.
Intertrigo skin rash
Skin rashes can affect anybody of all ages. It’s usually a symptom of underlying health conditions like allergies or viral and bacterial infection.
If you’re experiencing a rash in your butt crack, it must be an intertrigo.
An intertrigo usually appears in parts of your body where large skin folds rub against each other. The friction creates a moist environment that may welcome bacterial, fungal, or yeast infections.
You may feel the following symptoms if you have intertrigo rash:
- Red or reddish-brown rash on the butt crack
- Itchy, prickly, or burning small bumps on the skin
- Raw and inflamed skin with cracks which, may look like they’re about to bleed
- Bad and foul smell on the inflamed skin
Below are the things you can do to prevent getting an intertrigo:
- Keep the area clean and dry
- Wash the area regularly, especially after you sweat and
- Pat the area to dry (Don’t rub!). Drying the skin with a blow dryer set on cool or low mode may also help.
Below are some of the following remedies to treat intertrigo:
1. Apply topical treatments
You may use the following topical treatments in controlling pain and itchiness from your intertrigo:
- Zinc oxide ointment
- Petroleum jelly (Vaseline)
- Talcum powder
- Aluminum sulfate
- Tea tree oil. It has an anti-inflammatory activity that reduces itching and inflammation.
- Coconut oil. It may prevent bacterial infection.
- Anti-chaffing or barrier gels
2. Use antiperspirants
Antiperspirant works on the butt too! It blocks or controls how much you sweat in that area.
When you have intertrigo, and it comes into contact with sweat, it might cause your symptoms to aggravate and could also start an infection.
There are over-the-counter or prescription-strength antiperspirants available that work on other areas of your body other than just your underarms.
But, it’s worth trying swiping a good amount of your underarm stick and applying them on your bum or on the affected area.
3. Wear a comfortable cotton underwear
Avoid synthetic clothing that may cause friction on your butt crack. Wearing cotton-made and breathable underwear or pants may help in reducing pain.
In severe cases of intertrigo that involve infection, prescription medicines and creams are necessary. Treatments will depend on the type of infection you have.
For intertrigo with a fungal infection, common medicines include:
- Nystatin and azole drugs like miconazole, ketoconazole, or clotrimazole
- Antifungal drugs with low doses of corticosteroid for very itchy intertrigo
- Antifungal oral drugs for a severe intertrigo
For intertrigo with bacterial infection, treatment includes:
- Topical antibiotics like fusidic acid cream or mupirocin (Bactroban)
- Oral antibiotics such as penicillin, flucloxacillin, or erythromycin for severe bacterial infection
- Low-potency corticosteroid and antibiotic soap to reduce itchiness
Intertrigo in babies
Babies are at high risk of getting intertrigo because of their delicate skin. They are also prone to moisture due to too much drooling and wearing diapers.
- Always keep their butt area clean and dry by washing with mild soap and patting it with a towel. You may also apply talcum powder to absorb extra moisture.
- Change your baby’s diaper’s on time. Use only absorbent diapers, and make sure to wrap them around loosely to make enough room for your baby to move around comfortably.
- Apply over-the-counter creams with zinc or cod-liver oil on the affected area.
- Schedule a check-up with their pediatrician if the rashes become infected or symptoms persist after a few days.
While skin rash is a common skin condition, many people aren’t familiar with pilonidal sinus disease. Both may cause intense pain and discomfort on your skin, affecting your daily activities.
It’s best not to hide any sore skin feeling in your butt crack, just because it’s embarrassing. Early detection of its causes may prevent you from infection. Thus, you won’t have to deal with intensive treatments such as surgery.
Please tell your doctor immediately if you notice a small or cluster of holes in your butt crack. You may have to clean and dry this area regularly and remove unwanted hair to prevent it from growing.
If the sore becomes itchy and the skin turns scaly and inflamed, wash the area and pat it to dry. Apply talcum powder or antiperspirant to reduce sweating and moisture in your butt crack. Use zinc ointment to relieve itchiness and irritation. When symptoms come back or worsen, please see your doctor immediately.