Intensely itchy, red rash on scrotum / groin and itchy legs

[a person]

I'm 24 years old.

I have an intensely itchy, red (bright red in places), somewhat scaly rash on my scrotum / groin and itchy legs.  In case it's relevant:

For ~6 months have had throat irritation, constant feeling of need to cough or clear throat.  Cause unknown, less pronounced recently.

~4 months ago constant bloating / burning sensation in lower abdomen started, had 2 weeks of Levsin, no help.  Cause unknown, still experiencing.

My memory about when rash started is fuzzy -- prob. 1 to 1-1/2 months ago.  Assumed jock itch and treated w/ Cruex spray for about a week -- itching probably wasn't completely gone then.  Was using Lotrimin spray at same time for long ignored athletes foot.  Began Cruex again about 3-4 weeks ago.  I'd gently wash groin with just water in the morning and at night, pat dry with towel, blow dry on cool, apply Cruex.  Did that for two weeks, didn't relieve problem.  About 1-1/2 weeks ago began using Lamisil cream.  Used for about 5 days and stopped because it wasn't relieving problem.

Legs have been increasingly itchy, especially in bed at night.  As soon as I get in bed legs are itching like crazy, kind of a tingling itch shooting around the surface of legs.  May have started before groin rash, thought maybe I spread fungus from feet to legs from touching in bed at night.  No obvious rash on legs, perhaps faint, patchy redness, but not blatant like on scrotum.

Past couple days itching has been more in groin folds, less on scrotum, though visible rash most intense on scrotum.  Rash extends to underside of penis some, but not much itching there.    Itching has been intensely uncomfortable, trouble sleeping and concentrating at work.  Taken Benadryl capsules to sleep easier and used Sarna lotion with some success to subdue the itching on my legs.

Bland lotions don't seem helpful, in the case of groin they just seem to add discomfort of a greasy feeling.

I wear cotton boxers, usually only wash groin with water, practice good hygiene, keep my groin clean and dry, work in office, don't sweat much, am not overweight.

Have tendency for dry skin in winter, mostly knuckles and backs of wrists, but it hasn't really caused serious discomfort.

Symptoms definitely not STD related.

Jock itch seems unlikely because 2 diff. treatments didn't work, rash on scrotum, can't see telltale border of infection, wouldn't explain itchy legs (though maybe groin/leg symptoms unrelated).  Hate to say that scabies seems to best fit the profile.  Seems like a possibility because of time frame (symptoms have been at their worst for 1-3 weeks), intense itching, worst on groin, worse at night (legs anyway).  Seems unlikely because symptoms only below waistline, I live alone / haven't been in "high risk" environment recently (except maybe for visit to doctor's office about 2 months ago).

What could be going on here?  What do you recommend I do?  Help please!

P.S. I won't use hydrocortisone.

[Alan Rockoff, MD]

Your rash sounds somewhat like eczema to me.  The itching in various sites could be eczema, or it could be anxiety from worrying about the eczema in the groin.  (Your detailed description of sore throat and bloating suggests concern with body sensations that is probably irrelevant and not doing you any good.)  Scabies is possible, I suppose, but scabies itch is all over, not primarily in the groin, and besides, doctor's offices are not "high-risk" areas--you get scabies from close body contact, bit exam tables.

Groin rashes that don't respond to jock-itch (antifungal) creams are probably eczema.  Hydrocortisone would make these go away promptly.  You write: "I won't use hydrocortisone mean?"  I assume that this is out of fear of cortisone, which if so is quite misplaced, and again is not doing you any good.

Please see a doctor and get proper diagnosis so you can get rid of the rash and stop cataloging your symptoms with such meticulous care.  There are non-steroid treatments for eczema (Elidel, Protopic) which can be used if judged appropriate.)

Take care.

Dr. Rockoff

[a person]

Thanks for the quick reply, I appreciate it.  You seem to think I'm some kind of hypochondriac, but that's not the case.  I have some legitimate health concerns and I mentioned them in case they could be related to the problem I asked you about.

The information I've seen on scabies isn't real clear about the symptoms.  Most articles mention something like "The most common sites for scabies are: . . . pubic and groin area,  . . . occasionally the penis and scrotum" (http://scc.uchicago.edu/scabies.htm) which is what gave me the idea that the itching might be localized to certain parts of the body.  But if that's not the case, then I think I can be confident it's not scabies because there's really no itching above my waistline.

It's hard for me to visualize a microscopic mite first coming into contact with the body.  I wondered if it's not possible for something like the following to happen: a person gets infected with scabies, goes to their doctors office and sits in a chair in the waiting room, mites are transferred from the person to the chair, an hour later I come in and sit in that chair and mites get on me.  Maybe it's not the typical way the infection is spread, or even likely, but I don't see anything that wouldn't make it possible, based on what I've read.  In a general sense, I consider a place where sick people congregate to be a high risk environment for my health.

Yeah, I do have a fear of cortisone -- it sounds like a powerful, dangerous drug to me that is treated pretty casually.  I've also had experiences with doctors that are really only interested, at best, in covering up your symptoms and not really addressing the cause of a problem.  I can't tell you how many times I've read "My doctor told me to use hydrocortisone for something or other.  It made it better for about a week, then it got a lot worse."  I'll look into hydrocortisone further though based on what you've said.

I'd love to stop cataloging my symptoms -- as soon as they disappear.  For the moment, though, I wanted to give you as much detail as possible so you could give me your informed opinion, which you've done and I'm grateful for it.

Thank you.

[Alan Rockoff, MD]

During WWII the first studies on scabies were done in the British army.  They had scabies victims sleep in a bed, then had volunteers use the same sheets--they didn't get scabies.  That should give you an idea of how hard it is to transmit without direct body contact.

As for cortisone "covering up symptoms," yup--that's what it does.  That's what almost all the skin creams we use do--except perhaps antifungals, when there is a fungus.  Rarely are root causes known.  Wish it were otherwise, but it isn't.  But that doesn't mean you have to suffer with your symptoms.

Dr. Rockoff

[a person]

This is a perfect example of the kind of conflicting information you will find about a medical condition.  If I remember correctly, almost all of the articles I have read on scabies mentions something like this: " . . . [mites] can live in bedding up to 24 hours. . . . (Getting Rid of Scabies) Bedding and clothing must be washed or dry-cleaned."  (from AAD -- http://www.aad.org/pamphlets/Scabies.html)

Even worse from another article: "Except in severe cases inanimate objects such as clothing, bedding or furniture do not spread mites that cause scabies. . . . Avoid physical contact with infested individuals and their belongings, especially clothing and bedding." (http://healthlink.mcw.edu/article/955152083.html).

Don't get me wrong, I /prefer/ your version, but I don't know what to believe at this point.

Re: cortisone -- like I said, I will look into it further, but even taking for granted that covering up the symptoms is the best that can be done, I find it hard to believe that this one drug could be essentially the only treatment option.  Whenever possible I prefer to use natural substances.  If that's not possible in this case, I'd still prefer to use a less powerful drug if possible.

[Alan Rockoff, MD]

Mites can indeed live in bedclthes for up to 24 hours.  Of course bedding should be washed.  My point is only that transmission from bedding is difficult, and not likely to occur from an exam table.

Dr. Rockoff

[whw]

I had very similar symptoms a few months ago and went to my dermatologist.  He diagnosed it as a yeast infection, treated it with antibiotics and it cleared right up.  Good luck.

[anta]

I completely sympathise with you. I am 26 years old (female) and have been suffering from intense itching and tingling on my feet and lower half of legs for 7 months now. Initially it started in small areas on my feet, spreading all over the foot, ankles and now legs. It is worse when I have been walking, running and also gets bad when i am in bed (i think due to heat). I have been to several doctor and tried 6 different antifungal creams of varying intensity. Non worked. I then went to see a dermatologist who did an allergy "patch" test. When he discovered that I wasn't allergic to anything he dismissed my complaints and just said oh well "you're not allergic to anything, I can't see evidence of a fungal infection, you just have to live with it"!!.
I am so sick of this now and really don't know where to turn - help needed!!. It constantly keeps me awake to the point that sometimes I seriously feel like putting my feet in boiling hot water just to get rid of the itching.
If anyone out there has any advice I would love to hear it.

[Bransonland]

For over a year I have had an itchy red rash on my scrotum and legs.  My penis is itchy as well.

My doctor first prescribed my problem as jock itch, but after several weeks the symptoms only got worse.  He referred me to a dermatologist, who determined it was Excema.  For a year now, I daily apply excema cream so I can live with the itch and sleep at night.

But it's not going away, only getting worse.  I'm starting to think I have scabies.  I sleep with my two dogs and probably don't wash my sheets as often as I should.  

I need to go back to the dermatologist but I find the experience to be very embarrasing and uncomfortable.  It doesn't help that the doctor's office is cold and makes my Little Man shrivel up and look small in front of all those nurses.  

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