Extensive chronic perianal pyoderma associated with persistent inflammation caused by wearing the same unwashed underwear for more than ten years.

Key Clinical Message: Poor personal hygiene wearing the same unwashed briefs, and prolonged sitting have led to the development of chronic perianal pyoderma. This can be confused with hidradenitis suppurativa and must be differentiated as their treatments are different. Abstract: There are potential risks of persistent inflammation resulting from poor personal hygiene. This comprises wearing the same unwashed briefs and prolonged sitting posture that led to developing chronic perianal pyoderma (CPP) in a smoking man. CPP can be confused with hidradenitis suppurativa, requiring differentiation as their treatment strategies distinctly differ.