Red bumps on my butt keep rearing their ugly heads

Dear Desperately embarr-ASS-ed,

Thanks for the pun, and sorry you're feeling so frustrated. Those cyst-like bumps you're describing could unfortunately be caused by a number of different factors or medical conditions. Continuing discussions with your doctor and dermatologist to identify the root cause and find a successful treatment may be the best option for removing those pesky lumps, even though the process of trial and error may be frustrating. 

While it's impossible to make a diagnosis via the internet, there are a few potential conditions that may match the description you've provided:

• Folliculitis involves the growth of tiny little pockets of infection, sort of similar to pimples, that form around the place where a hair sprouts (the hair follicle). These pockets might be filled with fluid or pus, or might appear as red bumps that crop up around pieces of hair. Folliculitis is usually caused by bacteria (such as staph), although other microorganisms, such as yeast, are sometimes responsible. Folliculitis can develop due to shaving nicks or hot tub use, and can be worsened by wearing tight clothing. Infections may be superficial and only impact part of the follicle, or they can overtake the entire follicle in what's called deep folliculitis. These bumps can become itchy or sore and may cause physical discomfort or embarrassment. Shaving gently (or not at all), and wearing loose clothing may help to prevent infections from developing. Though they're likely to go away on their own over time, a health care provider may prescribe antifungal or antibiotic medications to heal the infection if it persists.
• Boils are similar in appearance to folliculitis, but they're freestanding, so they don't appear just around a hair follicle. They can appear in clusters, sometimes called a "carbuncle" and may be caused by sweat or the friction of skin against clothing or other sources. Once the skin breaks, bacteria can enter, causing the raised bump and inflammation. Boils can also have pus or fluid within and typically are caused by bacteria, yeast, or other microorganisms. Keeping your skin clean and covering any cuts or wounds can help to prevent boils from forming. 
• Keratosis pilaris is a usually painless condition associated with small bumps on the body, typically on the upper arms, thighs, cheeks, or buttocks. The bumps are typically quite small and might appear with dry patches of skin. Usually, keratosis pilaris is genetic or might be caused by other skin conditions such as dry skin or eczema. Because of this, there's no way to prevent keratosis pilaris. That said, the bumps are harmless and can usually be tamed using moisturizer or prescription creams, if needed, though in most cases, keratosis pilaris will disappear naturally by age 30.

Though a health care provider's diagnosis and advice is the most sure way to find a successful treatment, there are a few general at-home remedies you can try as well. Try placing a hot compress on them for 15 to 20 minutes at a time, several times a day, or sit in a nice hot bath to help them come to a head and drain (although it may take about a week for them to do so). Once the area is draining, put some antibiotic ointment over it and bandage the spot; reapply the ointment and re-bandage it three or four times each day until it appears totally healed. Also, make sure to thoroughly wash your hands and any towels or clothing you have used. It's terribly tempting, but don't squeeze them! You could drive the infection deeper, resulting in an even greater infection.

Additionally, you can keep the area clean by washing with mild soap and drying the spot thoroughly. If you have sensitive skin, you may want to avoid any harsh ointments or solutions such as alcohol, or even soaps with perfumes or dyes — strong soaps and certain chemicals in cleansers can make sensitive skin irritated and more prone to infection, rather than less. Have you tried just washing the affected area several times a day (rather than several showers a day) and using only mild soap? 

Some at-home acne treatments also may provide relief. However, it's recommended that you discuss the use of medications and other products with your health care providers before you try them, especially if you have sensitive skin, to avoid further irritation. Some of these treatments include the use of topical tea tree oil, oral zinc, or brewers yeast supplements. Each of these have their benefits but may come with unwanted side effects, ranging from skin irritation or redness to bloating or diarrhea. A health care provider can help figure out what treatments are most valuable to you, with the least negative impact.  

If these measures don't improve your bumps, if you're getting more and more, if the cysts are located between your buttocks, if they're increasingly red and painful, or if you develop a fever or other symptoms, you may need to see your health care provider to have the bumps drained and to be placed on oral antibiotics. Unfortunately, some people are prone to these kinds of eruptions, and you may find them rearing their ugly heads on an occasional basis. You aren't alone in this experience, and with some trial and error, hopefully you can find the solution that works best for you!