1: Rest and recovery. I used powder and kept the area clean and dry. I didn’t totally stop riding, but did swap saddles.
2: On washing your kit: be careful what detergent you are using, and make sure it rinses out well. Don’t use fabric softener either. I use ASSOS’ detergent and sensitive Tide interchangeably, and do three rinses and extra high spin. Things are very nearly dry, and there is no residue/bubbles in the door threshold.
3: Yes a bike fit is important, but you can make some adjustments yourself. I nearly always swap a shorter stem for instance, and have a perfect cleat position, and saddle setup that was confirmed by a rather worthless fitting once. (Check that angle and keep an eye on it over time)
4: Again, treat the injury with warm showers or a bath, keep it clean and dry, and use lotion or cremes before riding. Fiddling with bike fit: Make only ONE CHANGE at a time, and measure what you changed. However also look at how you are on the bike, and take a good deal of time to asses whether you actually feel comfortable on it. Too stretched out, too cramped, too uncomfortable?
5: Not seeing a doctor? Unless it’s bleeding and infected, a saddle sore is not going to need a physician’s care. I had bilateral sores and (unfortunately) am married to a physician, and she laughed. ‘It’s not falling off, so change something, or stop riding’. And also like I’ve said already: She reinforced to keep it clean and dry, and either adjust the position on the saddle, or replace it. (I was using a saddle that had very little padding, and riding for hours every day, and also didn’t realize that the seat position was moving slightly because of a poorly designed seat clamp) She did say that if it got much worse, it would develop into a medical problem. (People in ‘care facilities’ get pressure wounds a lot, and they do also often get infected and can kill them. Seeing people with sores that expose bone and tendons is horrific, and the pain can be excruciating, so don’t take it lightly, but do things you can do before it gets that bad)
6: Seeing a dermatologist is going to be interesting. I’ve heard of people having injections recommended. Yeah, um… Your saddle is riding on a spot on your butt with little padding over a hard bone. Adjust the saddle to move that pressure to another area, and ‘get a different saddle’.
7: Oh yeah. One other thing my wife said was that I was spending so much time with my ass on a vinyl covered brick, rocking back and forth, riding my bike on a moist and obviously abused butt. It was a ‘perfect setup’ for problems. Yeah, I took about a week off, and religiously cleaned and powdered the spots. In the end, fixing the saddle issues helped so much. Keeping it clean and dry certainly did too. Hot water helped incredibly too. I actually got to the point where I was still riding during my recovery. I just found different spots to abuse.
What hit me was how quickly the spots developed (or I totally ignored them) and how they changed some of the things I did. I tossed some underwear that rode right over those spots. I couldn’t wear some of the ‘normal’ shorts because of where pockets rode while I was walking. Even my jeans caused issues with my wallet at the worst of it.
Hygiene, new saddle, adjust your position, some time off, be good to yourself.
Oh, one last thing that I discovered: I was allergic to the chamois cream I was using. Yes, seriously. I told someone at the LBS, and after laughing nearly hysterically said that was unusual and likely very painful. YEAH. NO KIDDING!! I’m embarrassed it took me so long to make the connection, but if you use a product, maybe consider swapping brands for a while. (I use the ASSOS cream, and it my butt seems to really like it)
I’ve mentioned ASSOS a few times, but don’t receive anything from them at all. I just tried to find a better way, and found products that seem to work well, for me. Don’t be afraid to try new products.
OH, also, how old are your shorts/bibs? I also replaced some of my bibs, and found the ‘Wahoo edition’ from Le Col that had a thicker pad and fit very well (and then they dropped them and, well, the quest for bibs like those continues. Old bib pads lose all resilience and essentially go flat, losing any cushion or absorbency)
Good luck! Saddle sores sure are a PITA…