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Date of last update: 10/18/2017.

Forum Name: Dermatology Topics

Question: "crater" on butt cheek, dry smelly pus

 MKB1115 - Tue Mar 02, 2010 11:05 pm

I have had a "crater" on my left butt cheek for about 10 years now. It looks like a huge dimple. About every couple of months I have to squeeze it to get out some of the dry, white, smelly pus. Never any blood and it is never discolored. The pus actually comes from two little holes side by side but in the same "crater". There is no pain, just an annoyance and being self conscious of it. I have read up and looked at pictures and diagrams of pilonidal cysts, but that is not where mine is located (inbetween the cheeks at your tail bone), mine is actually on the cheek itself. I have never gotten the courage to ask a doctor about it. Any ideas and what could possible treatments be? I could maybe post a picture if it would help.

Thank you.
 Dr.M.Aroon kamath - Tue Apr 06, 2010 4:39 am

User avatar Hi,
I agree with you in that a 'Typical' pilonidal sinus or cyst would be located in between the cheeks of the buttocks close to the tail bone.Generally the 'primary' cavities of pilonidal disease are situated in the midline and later on, secondary cavities may form off-midline.Those with secondary cavities may be referred to as 'complicated' pilonidal disease.The distance from the midline can be variable.

It is fairly common to find midline 'pits' (in the natal cleft) in people with pilonidal disease.If these 'pits' are present, they would support the diagnosis of pilonidal disease.

The other possibility is a sebaceous cyst. Due to prior inflammation and sorrounding fibrosis,they may appear depressed in contrast to the abundant sub-cuteneous fat in the buttock.

Sebaceous cysts need to be surgically excised.
Pilonidal disease may be managed
- non-operatively (attention to personal hygiene, keeping the surrounding area free of hairs, antibiotics when necessary etc) or
- by surgery.
Best wishes!

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