Apologies for the long story and the TMI but I want to be as detailed as possible.

I am a 30 yo male. For 8 years I've had this irritation coming and going on the perianal area. The initial breakout back in May 2015 was the worst. There were clusters of bumps, redness, and a stinging sensation when hit with water all over the area. It was so bad the doctor thought I had genital herpes when he first looked at it but the culture test came back negative. Its also not jock itch.

Since then it's been a series of dermatologist visits. I've seen about 6 or 7 derm doctors since then. I have had multiple cultures and biopsies (of the bumps). Nothing came from those. I've had MULTIPLE STD tests, especially, for herpes, and during a flare up, and all negative. They basically diagnosed with folliculitis.

The frequency of occurrence has changed over the years. In the beginning (2015-2016) it would occur every 3 or 4 months. Since the the frequency increased to every month to every couple of weeks.

The meds they've put me on over the years are (There have been many so I can't remember all of them):

• Mupirocin (for bacterial) • Ketoconazole (for fungal) • Triamcinolone (for inflammatory) • Clindamycin • Eucrisa • And a pill that was called doxy something (can't remember the name)

I did notice that after washing the area with Hibiclens around 2018ish, the amount of bumps that would form greatly decreased so that was something. The hibiclens also made the irritation go away temporarily too. If I had a flare up I'd use the hibiclens and then I'm clear for a little while. But last year the hibiclens seemed to not work as well.

There have been times where the area may feel tender for a day or 2, right before a break out, kind of like a warning. This happens sometimes but not all the time.

I've also noticed at a few times, right before a break out the area would become incredibly itchy. And then the next day there was a full on breakout. Honestly I can only remember this situation happening 2 maybe 3 times these past 8 years since this started. Definitely not a regular thing. And definitely not a frequent occurrence like the tenderness as explained above. The last time this happend was once last year.

Another thing I noticed is that a year ago I went to a bathhouse with saunas and steam rooms. Before I went in I was clear, no flare up. Then when I got back home to shower there was a full on flare up. Its so weird.

Last August, a dermatologist put me on a 1 month treatment plan: Triamcinolone for 2 weeks, and then Ketoconazole for another 2 weeks. After the first two weeks of Triamcinolone, it seems to have subside but then it started to flare up a little. I tried the Ketoconazole for the next 2 weeks and that made it subside as well. Eventually of course it came back. HOWEVER, ever since doing that 1 month treatment, the size of the area of irritation GREATLY reduced. I used to get it all along the anal crevice from the top of the crack and all along the cheeks to the bottom almost approaching my scrotum. NOW the area approaching the scrotum seems to be the only area that irritated

I just had my 6th (and hopefully last) laser hair removal of the perianal area this past Tuesday (May 2nd). I read that laser hair treatment is a way to cure folliculitis. But this session, a new doctor noted that after looking at the area he doesn't think it's folliculitis and that it looks more akin to skin erosion. I explained that in the very beginning all those years ago there were clusters of bumps, but now not so much. He still didn't think it was folliculitis, OR that it could have been folliculitis in the beginning and then something else developped. But he went ahead with the final laser hair treatment just so we can see if it works. But he said that I should prepare for the possibility that this is something I'll have for life which is very disheartening.

Basically I just want to know if anyone has had or is having an irritation like this? And if any professional can give their opinion?

I'm attaching some photos. These are from last summer right before that month treatment, May 1st the day before the 6th laser hair removal session, and today May 6th. (I don't have any photos from 2015 from the very first breakout, apologies. But it looked a 100x worse than these)

Thank you in advance!