Taking a break to sit and rest might not sound so appealing if you’re living with hidradenitis suppurativa (HS). Sitting might actually be painful, especially if HS lesions affect your buttocks.

“I’m having serious problems with HS on my right butt cheek,” one myHSteam member wrote. Another member said, “I am at my sickest when I have them in my bottom.”

Also known as acne inversa, HS commonly affects areas of the body like the buttocks, armpits, and groin. Understanding how to manage symptoms and find relief is important, especially when painful nodules develop in sensitive areas, such as between or below your buttocks.

Symptoms of Hidradenitis Suppurativa on the Buttocks

The symptoms of hidradenitis suppurativa vary depending on the type of HS, severity of the disease, and area of skin affected. The type of HS is characterized using the Hurley staging system:

• Hurley stage 1 — Single or multiple lesions with minor scarring
• Hurley stage 2 — Single or multiple lesions with some tunneling and scarring
• Hurley stage 3 — Multiple interconnected lesions with extensive tunneling and scarring across a large area of skin

Risk factors for HS generally include having a family history, smoking, being female, and having a high body weight, according to Mayo Clinic. Early symptoms of HS on the buttocks include pain, burning, itching, and excessive sweating. These symptoms may occur for 12 to 48 hours before skin lesions form.

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Skin lesions can appear on or between the buttocks and on the perianal area (skin surrounding the anus) and can last for days to months. A lesion can appear as a deep, pea-size bump similar to an acne cyst or boil. Some skin lesions will grow and burst, draining foul-smelling pus. Over time, lesions may leave scars and form interconnecting tunnels under the skin. Lesions can also disappear and then reappear. “I have multiple painful boils and tunnels under the skin. My skin has darkened, and I have a burning sensation,” shared one myHSteam member.

Treating Hidradenitis Suppurativa on the Buttocks

Although there’s no cure for HS, several treatment options may help relieve your symptoms and reduce flare-ups. Your dermatologist will recommend a treatment plan based on your type of lesions, area of skin affected, and severity of HS. Commonly used treatments for mild HS (Hurley stage 1) include:

• Topical agents
• Topical antibiotics
• Pain relievers
• Oral antibiotics
• Corticosteroid injection

One member from myHSteam shared their experience with topical agents: “Using lidocaine has somewhat helped me with the pain on my buttocks. I completely cover the area of skin with the cream, gently rubbing in light circular motions. I don’t cover my lesions, and I let the medication dry. I only cover my lesions when they are leaking.”

Moderate and severe forms of HS (Hurley stages 2 and 3) may require a combination of topical and oral medications and other therapies. Medications that may be recommended for people with moderate to severe HS include:

• Oral antibiotics
• Oral retinoids
• Oral anti-inflammatory medications
• Corticosteroids
• Hormonal medications
• Biologic medications

Other therapies, such as laser hair removal and surgical treatments to remove damaged tissue, have shown some benefit for treating moderate to severe HS. Laser hair removal may also help people with mild HS.

How To Manage Hidradenitis Suppurativa on the Buttocks at Home

In addition to using the HS treatment recommended by your dermatology team, you might consider ways to manage HS flares on your buttocks at home.

In the early stages of HS, you can manage your HS flare-ups by following these at-home tips:

• Use only gentle skin products.
• Stop using loofahs, washcloths, or brushes to clean your skin.
• Steer clear of breakouts on the buttocks when shaving.
• Clean buttocks daily with antibacterial soap or cleanser.
• Wear loose-fitting clothing to prevent rubbing or friction against the skin.
• Use a warm compress or heating pad on the buttocks for 10 minutes at a time.
• Keep your skin cool and dry.

Some members on myHSteam also shared their at-home tips:

• “Warm baths with pure Epsom salt soaking solution.”
• “Bleach baths!!!!”
• “I use nonstick pads on my buttocks, which don’t hurt when I take them off.”
• “Keep your buttocks dry and clean.”
• “I apply a clear petroleum jelly to avoid further irritation to draining lesions.”

Speak with your doctor about the best options for your HS and before making any lifestyle changes or trying at-home strategies like those above.

Relieving Pain

Having HS lesions on your buttocks may make it painful to walk, sit, exercise, or even go to the bathroom. To help relieve the pain so you can get back to your normal activities, consider using over-the-counter (OTC) remedies after getting your health care team’s OK. Strategies such as these may offer relief:

• Use OTC topical creams with numbing qualities, such as those that contain lidocaine, menthol, pramoxine, benzocaine, or prilocaine.
• Take pain medications such as ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs).
• Use mild heat, like a warm compress, if a lesion on your buttocks is inflamed and looks like it may burst soon.
• Apply an ice pack if the lesion is swelling but not close to bursting or if one recently burst and is painful.

If these strategies don’t work, consider asking your dermatologist for a referral to a doctor who specializes in pain management. They can pinpoint strategies that may help reduce your pain and improve your quality of life.

Bandaging HS Lesions on Your Buttocks

Wrapping or bandaging HS abscesses may absorb drainage and ease friction where your skin rubs against your underwear or pants. Finding the method that works best for you may depend on where the HS lesions are located and could take some trial and error. For instance, some people find that sanitary pads work well, while large self-adhesive bandages work best for others. Ask your dermatologist for recommendations on the best bandage types for you.

Always wash your hands and the affected area of your buttocks before applying a bandage. If your dermatologist recommends it, consider applying a topical antibiotic ointment or petroleum jelly to the lesion site before putting on the bandage.

Managing Other Risk Factors

Several risk factors have been linked with HS. Changing certain lifestyle habits or adopting new ones may also help control the skin condition.

Weight Loss

Researchers have reported that being overweight or obese or having metabolic syndrome is an associated risk for developing HS. Weight loss or maintaining a healthy weight may reduce your risk of an HS flare-up or worsening symptoms. Many people with HS on their buttocks avoid physical activities because of their painful skin lesions. However, swimming may be a great exercise option to help relieve painful lesions.

Smoking Cessation

Smoking cigarettes is associated with HS. Researchers have found that around 70 percent to 90 percent of people who develop HS also smoke. Quitting can help prevent worsening symptoms and reduce your risk of flare-ups.

Diet

What you eat may affect your HS. Certain foods may trigger flare-ups, and others can help prevent them. Some dermatologists have reported improvements in some people with HS who followed a Mediterranean or plant-based diet. Always speak with your dermatologist or primary care provider before changing your diet.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa, more than 44,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have HS symptoms on your buttocks? How do you manage them? Share your thoughts in the comments below or by posting on your Activities page.