Buttock Pimples: Folliculitis, Acne, Ingrown Hairs, and When to See a Doctor

Pimples on the buttocks are common and usually benign. The differential diagnosis includes:

• Folliculitis: S. aureus infection of hair follicles → pustules on erythematous bases. Hot tub folliculitis (Pseudomonas) is a distinct variant.
• Acne vulgaris: Comedones, papules, pustules; driven by hormones, friction (tight clothing), and occlusion.
• Ingrown hairs (pseudofolliculitis): Curved hair re-enters skin → foreign body reaction. Common with shaving/waxing.
• Keratosis pilaris: Keratin plugs → rough, follicular papules; usually asymptomatic.
• Hidradenitis suppurativa: Painful nodules/abscesses in intergluteal fold; chronic, scarring. Requires specialist care.
• Cysts/lipomas: Subcutaneous, mobile, non-inflammatory unless infected.

Self-Care Measures

• Loose cotton underwear
• Benzoyl peroxide wash
• Chemical exfoliants (salicylic or glycolic acid)
• Avoid picking
• Laser hair removal for recurrent ingrowns

Red Flags — See a Clinician If:

• Large, deep, painful nodules
• Spreading cellulitis
• Fever
• Recurrent despite OTC measures
• Scarring
• Suspicion of hidradenitis suppurativa