Fungus, Yeast Infection or Something Else?

A few months ago I developed a red rash on my scrotum (nothing on my legsarea).  No bumps or anything just intense burning, itching and very red.  I went to a dermatologist and he perscribed me Hydrocortizone 1%/ Iodoquinol 1% and suggested that I also use Zeasorb-AF along with it.  The relif subsided for a short period but after that it got worse.  Upon going back to the dermatologist he said that I might have a yeast infection and perscribed me with Ketoconazole 2% cream 2 x per day, Ketoconazole 200 mg tablets (21 days worth) along with Zeasorb-AF.  I am nearing my of the tablets (4 more days) and the red rash has really not subsided and has spread to my anal region (subsided after putting the Ketoconazole lotion on it).  The buring and itching subsided the first few days but now it is buring and itching as before (more burning now).  It seems to be at it's worst after getting out of the shower or when I am phiscially active and at night.  I have not changed detergents or soap I use for years.  I have had the same sexual partner for the last 8 years and prior to her I had a full set of STD tests run with everything coming out negative.  I did have a bad cold about 4 months before I developed the rash and need two different antibiotic treatments to get rid of wat ever I had.  I do currently take Atenolol, HCZT & Lescol for my blood pressure and cholesterol (I have been on these for years with no side effects).  I was wondering what type of rash this might be (fungus, yeast, or something else)?  It is starting to drive me crazy and I am a little nervous.  Could you please give me a suggestion on what this might be and how long should this take to heal.  also what I need to ask my dermatologist for the next time I see him. Thanks for your time and sorry for the long question.

[Alan Rockoff, MD]

I'm confident you don't have yeast, because the treatment you got would have taken care of it.  So I think you should get yeast, fungus, or infection off your mind.  My experience with red scrotum is that, although cause is unknown, the redness and sensitivity eventually subsides, and the less aggressively you treat it, the better.  I advise avoiding any sort of cortisone, however mild, and sticking with mild soaps, bland moisturizers, and perhaps one of the nonsteroidal anti-inflammatory creams like tacrolimus or pimecrolimus.  Your dermatologist can tell you about these and perhaps prescribe them.  You'll need patience, but you're not infected and in the end you'll be fine.

Take care.

Dr. Rockoff