Medical Edge Newspaper Column

Treating a Skin Split That Won't Heal

December 17, 2007
Dear Mayo Clinic:
My husband has been suffering from recurring split skin in the area above his anus, between his buttocks. He has seen a dermatologist and was told that it was intertrigo, although it does not look like the photos I've seen of this condition. There is no infection. The split is very painful. It heals, only to split again. He has tried various drying treatments, as well as treatment for yeast infection. Nothing has helped.

Answer:
From your description, it sounds like your husband has split (fissured) skin in the cleft between the buttocks, called the intergluteal cleft. If the fissured skin is in contact with or immediately above the anus, he should make an appointment to see his physician for an examination of the anus and rectum. Problems with hemorrhoidal tissue or other tissue in and around that area could be causing the skin to split.

If the affected area is an inch or more above the anus, then it may be a skin problem only. One of several skin disorders could be to blame. Intertrigo is a condition where skin becomes red and inflamed due to a combination of heat, moisture and friction. Although intertrigo can occur in this area, it is not as common as in other areas like the groin and armpits. Although you mention that there's no infection, bacteria, such as streptococcus, can colonize this area and create red, tender and inflamed skin. Psoriasis, a common chronic skin condition, can sometimes present in this area of the body as a "pinking" or redness of the skin in the cleft.

If he suspects one of these conditions, your husband should see another dermatologist for an evaluation and to review his family history for skin disorders. A thorough exam of his scalp, ears, fingernails and other skin surfaces can help determine if his condition may be the first sign of psoriasis or if another underlying medical condition may be causing it. The therapy for his condition depends on the results of this exam. If it is an infection, then it needs to be treated. If it is psoriasis, then treatment will need to be tailored to this condition affecting the intergluteal cleft.

Your husband should also be evaluated for diabetes, as some people who have diabetes can develop intertrigo or other similar skin conditions that fail to heal with appropriate therapy.

 Lawrence Gibson, M.D., Dermatology, Mayo Clinic, Rochester, Minn.