Perianal Pimples: When to See a Dermatologist or Colorectal Specialist

Perianal acne

Recently, I developed a pimple near my anus, which became somewhat swollen.
On the seventh day, I squeezed it, and a mixture of pus and blood (mostly blood) came out.
After squeezing, it shrank over the next few days but did not completely resolve.
After two weeks, I became concerned and visited a clinic specializing in hemorrhoids and fistulas (not a colorectal surgeon).
They diagnosed it as folliculitis.
By the 21st day, it had slightly swollen again (not as much as during the first week), and I squeezed it again, this time only blood came out.
It gradually shrank but still did not completely resolve (there is a palpable bump).
After one month, I consulted a colorectal surgeon at a major hospital.
The doctor suggested it might be folliculitis but did not rule out the possibility of a fistula.
They prescribed Defense FC tablets 300 mg three times daily and Curam FC tablets 875 mg/125 mg twice daily for seven days, advising me to monitor the situation.
Upon returning after finishing the medication, the doctor indicated it was likely folliculitis and suggested surgical removal if it swelled again.
Currently, the lump is less noticeable than before taking the medication, but I can still feel the bump.
It is generally not painful, and applying pressure with my fingers does not hurt much, but there is some pain when I press or poke it with my nails or a cotton swab.
Should I consult a dermatologist or return to the colorectal surgeon?

Niming, 20~29 year old female. Ask Date: 2019/09/01

Dr. Wu Yuxin reply Dermatology

Colorectal Surgery

Reply Date: 2019/09/01

More Info

When dealing with perianal pimples or any unusual growths in the anal area, it's essential to approach the situation with caution and seek appropriate medical advice. Based on your description, it seems you have been experiencing a recurring issue that has been diagnosed as folliculitis (inflammation of hair follicles) by a colorectal specialist. However, the persistence of the lump and the discomfort you feel upon manipulation suggest that further evaluation may be necessary.

Understanding the Condition
Perianal pimples can arise from various causes, including:
1. Folliculitis: This is an infection or inflammation of the hair follicles, often caused by bacteria, fungi, or irritation. It can present as red, swollen bumps that may ooze pus or blood when squeezed.

2. Abscess: A more severe form of infection that can occur if folliculitis is left untreated. An abscess is a collection of pus that can be painful and may require drainage.

3. Fistula: This is an abnormal connection between the anal canal and the skin, often resulting from an abscess. Fistulas can cause persistent drainage and may require surgical intervention.

4. Other Skin Conditions: Conditions like hidradenitis suppurativa or even benign cysts can also present as lumps in the perianal area.

When to See a Dermatologist or Colorectal Specialist
Given your situation, here are some considerations for deciding whether to see a dermatologist or return to a colorectal specialist:
- Persistent Symptoms: Since you still feel a lump even after treatment and it has not completely resolved, it is advisable to seek further evaluation. A dermatologist can provide specialized care for skin-related issues, including folliculitis and other skin conditions.

- Pain and Discomfort: If you experience pain, especially when manipulating the area, this could indicate an underlying issue that may need more than just topical treatment. A dermatologist can assess the skin condition and determine if there are any underlying infections or other skin disorders.

- Surgical Considerations: If the lump persists and is suspected to be a fistula or abscess, a colorectal specialist may be necessary for surgical evaluation and management. They can perform procedures to drain abscesses or repair fistulas if needed.

- Follow-Up Care: If you have already been treated by a colorectal specialist and they suggested surgery if the condition recurs, it may be wise to follow their advice. However, if you feel that the issue is more dermatological, a dermatologist can also provide valuable insights and treatment options.

Recommendations
1. Consult a Dermatologist: Given the nature of your symptoms and the fact that you have already seen a colorectal specialist, it may be beneficial to consult a dermatologist. They can evaluate the skin condition and provide treatments such as topical antibiotics or other medications that may help reduce inflammation and promote healing.

2. Monitor Symptoms: Keep track of any changes in the lump, including size, color, and any associated symptoms like pain or discharge. This information will be helpful for any healthcare provider you consult.

3. Consider a Second Opinion: If you feel uncertain about the diagnosis or treatment plan, seeking a second opinion from another colorectal specialist or dermatologist can provide clarity and reassurance.

4. Avoid Self-Manipulation: Refrain from squeezing or manipulating the area, as this can lead to further irritation or infection.

In conclusion, while both dermatologists and colorectal specialists can play a role in your care, the choice may depend on the specific nature of your symptoms and the findings from your previous evaluations. It is essential to seek professional advice to ensure proper diagnosis and treatment.

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