? Genital Dysesthesia

[daddyoh]

Hi,
I'm a family physician as a small FYI
A few weeks ago I began to develop mild soreness over my tailbone  it felt like a cut.
Mild enough for me not too worry
A few days later I began to develop itching only while wiping after toileting.

I figured I must have a mild dermatitis and started avoiding coffee etc other simple things

After maybe 10 nights of the above, Things came to a head a few nights ago when I developed severe itching preventing me from sleeping
For the first time i could also see skin changes-redness n the gluteal cleft

I saw a derm the next day: she looked and diagnosed perianal dermatitis nyd and Rx clobetasone ointment BID.

It's been 3 days and I'm not better

But what I'm worried about is that I now have itch over my scrotum, inguinal folds and base of penis. There is no rash there. Throughout all this I have not been scratching as I know where that can lead

So....I am worried this is some sort of dysesthetic problem more than a primary dermatitis. I have seen patients with 'red scrotum syndrome' before wondering if they are crazy and now worried I will become one of them. It has been all consuming the last few days

Your insight is appreciated.  If there are other meds I should consider let me know

Worried Family Doc

[daddyoh]

Thanks for the detailed response...very helpful.

[Dr. Kokil Mathur]

Hi!
Well, genital dysesthesia is a possibility which should be considered if all other causes are ruled out.

Since the itch started in lower back and affected the anus and gluteal cleft, with mild dermatitis like symptoms, the first thing to be ruled out is a worm infestation. This, as you know, can be ruled out by a simple stool test, and should include all the helminthes, giardia and amoebiasis. Worm infestation can cause an itch that may spread to scrotum and base of penis without appearance of a rash.

The second possibility is a fungal infection. Initially this may present only with an itch and a mild skin discoloration. Redness and other features develop over time. This can be in form of Tinea infection or it may be any other fungal infection and it can affect the folds like the gluteal cleft, the inguinal fold, the scrotum and base of penis. Another possibility is sweat dermatitis. It is also commonly known as jock itch and typically causes an itching burning sensation in the on penis/scrotum/groin fold/adjacent thighs.

You can keep the area dry and wear loose fitting clothes. Many treatment options are there like Clotrimazole 1%, Miconazole nitrate 2%, Tolnaftate 1%, ketoconazole, terfibnafine and Butenafine hydrochloride 1%. Try any ointment which contains a combination of at least two of them. The treatment may take about 4-5 weeks to produce complete results. You can take an anti-allergic by mouth to reduce the itch. Also cool compress also helps reduce itch and gives additional help if it is sweat dermatitis.

If you have recently changed any personal care products, then please stop using that product and see if it helps. Slight leakage from the anus can also cause a rash like area between the gluteal folds and can cause itch in the genital area. So this possibility too should be looked into, especially if you have bloating and gas. Another possibility which should be considered is genital herpes. Pubic louse is another possibility which should be considered.

If all of the above is ruled out and you do not benefit from the above mentioned treatment then possibility of genital dysesthesia should be looked into. This would need special treatment as you are probably aware of.

As a precaution, use only mild soaps. Use a menthol based moisturizer or cream after bath to help reduce the itch and burning sensation. Wear cotton undergarments and loose fitting clothes. Take a second opinion from another skin specialist. Until then please stop the use of clobetasone ointment as it contains steroids.

Hope this helps! Good Luck and take care!