Chronic Buttock Pain: Skin Issues or Something More? - Dermatology

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Chronic buttock pain accompanied by skin issues, such as periodic redness, swelling, and the presence of dark blood-like clots, can be quite concerning and complex. Given your description, it appears that you have been experiencing these symptoms for over five years, with a worsening condition in the last two to three years. The fact that multiple dermatologists have been unable to provide a definitive diagnosis or treatment suggests that the underlying issue may not be purely dermatological.


Possible Causes
1. Chronic Skin Conditions: While you have seen dermatologists, conditions like hidradenitis suppurativa, which is a chronic skin condition characterized by lumps in places such as the armpits and groin, could be a possibility. This condition can lead to painful abscesses and scarring.

2. Vascular Issues: The description of dark blood-like clots and thickened blood suggests that there may be vascular issues at play. Conditions such as venous insufficiency or thrombophlebitis could lead to similar symptoms, especially if there is poor circulation in the area.

3. Neuropathic Pain: Given the chronic nature of your pain, it could also be related to nerve issues. Conditions like peripheral neuropathy or even conditions affecting the sacral nerves could lead to pain that is perceived in the skin.

4. Autoimmune Disorders: Certain autoimmune conditions can cause skin symptoms along with systemic issues. Conditions like lupus or vasculitis can manifest with skin symptoms and should be considered, especially if you have other systemic symptoms.

5. Infectious Processes: Chronic infections, such as abscesses or even certain types of fungal infections, could lead to recurrent symptoms.

Recommendations
1. Seek a Multidisciplinary Approach: Since your symptoms are complex and have not responded to dermatological treatments, it may be beneficial to consult with other specialists. A vascular surgeon could evaluate for any vascular issues, while a rheumatologist could assess for autoimmune conditions.

2. Imaging Studies: Consider asking for imaging studies, such as an ultrasound or MRI, to evaluate the underlying structures and blood flow in the area. This could help identify any abnormalities that may not be visible through a physical examination alone.

3. Pain Management: In the meantime, managing your pain with appropriate medications or therapies may help improve your quality of life. Consulting a pain management specialist could provide you with options to alleviate your discomfort.

4. Lifestyle Modifications: If your condition is exacerbated by prolonged sitting or specific activities, consider making adjustments to your daily routine. Using cushions, taking regular breaks to stand and move, and maintaining a healthy weight can help reduce pressure on the affected area.

5. Documentation: Keep a detailed record of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable to healthcare providers in diagnosing and treating your condition.


Conclusion
Your chronic buttock pain and associated skin issues are likely multifactorial, and a thorough evaluation by a multidisciplinary team may be necessary to arrive at a comprehensive diagnosis. It is essential to advocate for yourself and seek out specialists who can provide a holistic view of your health. Given the complexity of your symptoms, a collaborative approach involving dermatology, vascular surgery, and possibly rheumatology will likely yield the best results in identifying the root cause of your discomfort and developing an effective treatment plan.