Recurrent Pustular Lesions in Groin and Thigh Area

Case at a Glance

A 27-year-old male presents with recurrent pustular lesions in the pubic region and thigh, concerning for possible hidradenitis suppurativa or recurrent folliculitis.

Patient's Story

The patient reports experiencing painful, pus-filled bumps in his pubic area for the second time, with the previous episode occurring several months prior in the same location. He also developed a similar pustular lesion on his thigh. The patient is a non-smoker with a history of commercial sex work contact approximately one year ago. He has been using petroleum-based moisturizer and an acne treatment product from Japan for the past two months to manage various skin bumps on his body.

Initial Assessment

Physical examination revealed pustular lesions in the pubic region and thigh area. The recurrent nature of the lesions in the same anatomical location raised clinical suspicion for either infectious folliculitis or an inflammatory skin condition.

The Diagnostic Journey

Given the recurrent presentation of pustular lesions in the groin area, differential diagnosis included bacterial folliculitis, hidradenitis suppurativa, pilonidal cysts, or sexually transmitted infections. The patient's history of commercial sex contact warranted consideration of STI screening, though the lesion characteristics and location pattern suggested a non-STI etiology.

Final Diagnosis

Based on the recurrent nature and anatomical distribution, the clinical presentation was most consistent with early-stage hidradenitis suppurativa, though bacterial folliculitis remained in the differential diagnosis pending culture results.

Treatment Plan

Initial management included topical antibiotic therapy and warm compresses for symptomatic relief. The patient was advised to discontinue petroleum-based products in the affected areas and maintain proper hygiene. Comprehensive STI screening was recommended given the patient's sexual history. Dermatology referral was arranged for definitive diagnosis and long-term management planning.

Outcome and Follow-up

Patient was scheduled for follow-up in 2-3 weeks to assess treatment response. Education was provided regarding hidradenitis suppurativa triggers and lifestyle modifications. Long-term dermatological care was recommended for ongoing management and prevention of recurrence.