Hello doctor, I have acne (inflammation) on the hair follicles on my butt for a long time, which goes on and off, but the marks and blackness of skin have been there forever. The marks are dry and persistent. When a particular one dries, the skin can be easily pulled off and it often has a tiny whitish needle in the middle. It does not pain, but the marks are really bad. I have just used home remedies like aloe vera and coconut oil. Please suggest a lasting solution.
Hi. I went through your case. Though photo are bit blurred. Upload a clear one if possible. (attachment removed to protect patient identity).  Characteristics you mentioned are spines, dry, and their persistence but again you said they go on and off. I can see some are having small pus. That is important, make it clear if they are always or have any seasonal variation. You did not mention itching, I want to be clear do they itch or not. Do you have a history of allergy in the form of itchy rash? Are these bumps only on buttock area or elsewhere also like elbow, neck, etc? Did they ever make large pus-filled abscess? Do you have any other medical conditions? It is a chronic and rare disease but to be sure I need above history. Then I may advise you a biopsy to confirm the diagnosis. Constitutional. Biopsy for HPE (histopathological examination) Keratosis pilaris, lichen spinulose, and follicular eczema. Ureative20 cream in the morning. Tretinoin 0.05% cream at night. Moisturizer. Review with history and photo then plan further.