Bottoms up, You Have a Butt Rash! 5 skin problems commonly seen on the butt.

So you have a butt rash. We appreciate when patients behave well in the office, but sometimes it’s necessary for them to show the dermatologist their butts.  We are over the moon to share with you 5 common skin problems found on a person’s backside (buttocks):

Genital herpes sometimes presents instead on the buttocks
Genital herpes sometimes presents instead on the buttocks

Genital herpes

 If you have been getting a recurrent sore on the exact same place on the buttocks, it would be a good idea to get screened for genital herpes.  Genital herpes? On the buttocks?    After the primary infection with genital herpes, the virus lives dormant in the sacral ganglion in the lower spine.  When the virus reactivates, it travels down the nerve toward the genitals—but sometimes takes an alternate route to the skin on a branch of the sacral nerve that serves the buttocks. This may cause a painful or itchy, recurrent butt rash. Herpes is a lifelong infection. The good news is that over time people tend to have fewer outbreaks. Many people with genital herpes have no symptoms at all–but they can still infect others. Treatment is not always necessary.  Treating genital herpes on the buttocks may include antivirals such as acyclovir, valacyclovir (Valtrex), or famacyclovir (Famvir). It’s important for pregnant women to let their obstetrician know if they have genital herpes to take measures to prevent infection of the baby during vaginal delivery.


butt acne
Acne on the butt? Well, not exactly.


“Butta face?” About 10% of people have a follicular papules on their buttocks–or butt acne.  It’s not exactly like the acne vulgaris we usually see on the face, which technically starts with microscopic white heads, but a kind of irritant folliculitis.  This may respond to benzoyl peroxide wash, antiperspirants, or antibiotics.  Further reading:  Acne treatment


keratosis pilaris butt rash
Keratosis pilaris- something both your arms and butt may have in common

Keratosis pilaris (usually a temporary butt rash)

This butt rash often appears to be butt acne. A clue is if you have the red or brown, scaly, follicular papules on the backs of your arms, you may also get them on the thighs and buttocks.  These lesions are a normal finding on some people.  It can be difficult to treat keratosis pilaris.  Sometimes exfoliating creams, such as salicylic acid cream, ammonium lactate lotion, or physical exfoliation can make the skin smoother—but the effects are usually temporary. Keratosis pilaris is more common in people with eczema, or atopic dermatitis. 


psoriasis butt rash
Psoriasis? Yes. It can cause a butt rash.


There are a variety of “red rashes” that dermatologists see that may look the same.    Drug eruptions. Pityriasis rosacea.  Syphilis.  Pityriasis rubra pilaris…and psoriasis.  Sometimes the key to distinguishing them is the presence of gluteal pinking, which is involvement of the fold between the cheeks of the buttocks.


buttocks mycosis fungoides
Mycosis fungoides- a types of skin cancer that sometimes presents as a butt rash.


Mycosis fungoides, or cutaneous T-cell lymphoma (CTCL), is a relatively uncommon type of skin lymphoma that can look like eczema or psoriasis.  This condition, versus sun-associated skin cancers, typically involves the double covered” areas of the body that get less sun such as the breasts in women, as well as the hips and buttocks.  This condition can persist for decades without changing life expectancy, but in some cases it is more aggressive causing sickness and death. Interestingly, unlike many other types of skin cancer, which more commonly occur in people with less pigmented skin, CTCL is more common in people with skin of color.   If CTCL, or another type of skin cancer, is of concern, see a board-certified dermatologist for a skin cancer screening. Make sure you tell the doctor about your concern in the buttocks area as this isn’t always checked.

The butt is just another part of the body with skin. There is more to butt rashes than diaper rash. If you have a problem in this area, don’t be shy to show your dermatologist.

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