I have intermittent acne on butt with permanent black marks. Please suggest solution.

Hi,

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I went through your case. Though photo are bit blurred. Upload a clear one if possible. (attachment removed to protect patient identity). Characteristics you mentioned are spines, dry, and their persistence but again you said they go on and off. I can see some are having small pus. That is important, make it clear if they are always or have any seasonal variation. You did not mention itching, I want to be clear do they itch or not. Do you have a history of allergy in the form of itchy rash? Are these bumps only on buttock area or elsewhere also like elbow, neck, etc? Did they ever make large pus-filled abscess? Do you have any other medical conditions? It is a chronic and rare disease but to be sure I need above history. Then I may advise you a biopsy to confirm the diagnosis.

Hi,

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I have seen the pictures. (attachment removed to protect patient identity). This is a hair follicle disorder and the cause is not exactly known. Your history rules out eczema, infection, and lichen spinulosus. Two main possibilities remain are DRIF and keratosis pilaris. They can be differentiated in histopathology only. However, the treatment remains the same. Keep it emoliated with moisturizer like aloevera. Avoid friction as much as possible. Ureative 20 cream and Tretinoin in the morning and evening respectively. Review after four weeks. In severe cases, oral drugs are also given but not needed in your case. Good thing is, it is seen to subside in adulthood. Plan a biopsy by a dermatologist once the lockdown lifts and send these differential diagnoses to a reputed HP lab. The differential diagnoses are Disseminate and recurrent infundibulo-folliculitis (DRIF), Keratosis pilaris rubra, Lichen spinulosis, Follicular lichen planus, Bacterial folliculitis, Pityrosporum folliculitis.