Recurrent Perianal Skin Breakdown with Consideration of Topical Corticosteroid Treatment

Case at a Glance

A 28-year-old female presents with recurrent skin breakdown in the intergluteal cleft area, likely secondary to mechanical trauma from hygiene practices, seeking guidance on topical corticosteroid use.

Patient's Story

The patient reports a several-week history of skin splitting at the superior aspect of the intergluteal cleft. She attributes this to frequent and possibly aggressive cleansing practices. The lesion is described as non-pruritic, with pain only occurring during washing when re-injury may occur. She notes minimal bleeding and describes scab formation that repeatedly breaks down before complete healing can occur. Her spouse has observed visible irritation in the area.

Initial Assessment

Physical examination by spouse reveals visible irritation in the intergluteal cleft. The patient describes a chronic wound that cycles between partial healing and re-injury. No significant bleeding reported, suggesting superficial involvement. Pain only with mechanical trauma during cleansing suggests the lesion depth is limited to superficial layers.

The Diagnostic Journey

The patient has self-diagnosed this as a mechanical skin breakdown related to hygiene practices. She is considering self-treatment with previously prescribed betamethasone dipropionate 0.05% cream, a high-potency topical corticosteroid. The cyclical nature of healing and breakdown suggests ongoing mechanical trauma preventing proper wound healing.

Final Diagnosis

Recurrent intergluteal dermatitis with mechanical skin breakdown, likely secondary to trauma from hygiene practices. Differential considerations include contact dermatitis, fungal infection, or bacterial superinfection.

Treatment Plan

Patient considering topical corticosteroid therapy with betamethasone dipropionate 0.05%. However, clinical consultation recommended to rule out infectious etiology before corticosteroid application. Gentle hygiene practices and barrier protection should be implemented. If no signs of infection present, short-term low-potency topical corticosteroid may be appropriate.

Outcome and Follow-up

Clinical response pending. Healthcare provider consultation advised to ensure appropriate diagnosis and treatment, particularly to rule out secondary infection before initiating corticosteroid therapy. Patient education regarding gentle hygiene techniques and wound protection recommended.