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A nasty pimple on the buttocks is a more common problem than many people might think. Usually pimples on the butt cheeks are caused by staphor strep infections, while cysts under the skin are due to acne bacteria.

Here's how you tell the difference and what you do.

1. Staph infections tend to form a little yellow dot in the middle of a red, circular rash. They get larger, but they spread out in all directions. This is the classical "boil" on the butt.

2. Strep infections tend to form a red rash without any pus. If the rash has any yellow "heads," it is staph, not strep. Strep infections spread along the curves of the body, including the curves of the buttocks.

3. Acne develops in a single pore. First the pore (not that you're likely to notice this happening on your derriere) narrows and gets clogged. Then it develops a red pimple. Then healthy skin may grow over the pimple, trapping the infection inside to form a cyst.

Different approaches work for the different kinds of infections.

1. For a staph infection, moist heat accelerates healing. Applying a warm, clean cloth (that you don't reuse before laundering in hot, soapy water so you don't spread the infection) increases circulation to the skin. This helps the immune system attack the infection. As long as the boil is small (less that 1 inch/25 mm across), it doesn't do any good to lance it, even if it is painful. Staph infections that form around an ingrown hair often drain on their own when they get large enough.

Larger boils can be opened, usually with dramatic relief of pain and inflammation. This isn't something you want to do on your own, not just because it's hard to reach back there. There can be multiple pockets of pus that have to be drained, and it is important to apply an antibiotic and bandage the site to avoid spreading the infection to other areas of skin.

2. Strep infections tend to form around the anus, especially in children. This is the same kind of bacteria that causes strep throat and impetigo. Usually it gets there on contaminated fingers. Touch the a spot of strep infection somewhere else, including on another person or a pet, touch the anus, and the infection is transmitted. That's why it is usually a good idea to wash hands both before and after going to the toilet.

Step infections are not lanced. They respond to topical applications of antibiotics, although Neosporin won't always work. (Lotrimin will not treat either strep or staph.) It's usually a good idea to get a doctor to write a prescription for the right antibiotic to give the quickest relief.

3. Acne can break out on the butt cheeks, although not immediately around the anus. This kind of acne can break out at any time of life, even in infants and old people. By the time it has formed a cyst, it's too late to use the usual methods of treating acne, but that doesn't mean treatment is impossible.

What's needed by the time acne has become a cyst is something to open the skin without injuring it. Usually this is some kind of retinoid drug (Roaccutane, Adipex, Tretinoin). These are chemically modified vitamin A, which stimulates rapid growth of the skin. Over a few weeks, the skin over the cyst opens up and lets the cyst drain on its own, painlessly and without any need for lancing.

There are retinoid drugs you get from your doctor that you take by mouth. These require lab tests to make sure you aren't developing liver damage. Because they can cause birth defects, at least in the US, women of reproductive age who take them have to be on two different kinds of birth control.

There are also retinoid drugs available over the counter and from Amazon. The products to look for are tretinoin gel products, not retinoic acid products. It's important that you keep the container tightly sealed between uses (the active ingredient can react with the oxygen in the air) and that you bandage the area you are treating after putting on the gel so your clothing does not rub it off. Within a few weeks, the cyst begins to open on its own, and then you just need to do normal acne care, only on your buttocks, not on your face, to keep the problem from coming back.

There are also other forms of acne that affect the buttocks, but they would be noticeable all over the body, and require medical treatment.

For a simple, single pimple or cyst on the buttocks, these methods will work more than 95 percent of the time.

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