Red rash on scrotum with thickened skin

[dunno sumthin]

About 5 months ago, my scrotum was massaged by a woman after she played with herself and probably had semen on her hand.  She also then used some kind of massage gel or oil as well.  5 days later my scrotum began to turn red.  I have been tested for HIV, HSV, chlamydia, gonnorhea and Syphilis..all negative.  Problem is my scrotum continues to be very red and non responsive.
I have been to a doctor, urologist and recently a dermatlologist.  I have tried cortaid ointment with just slight improvement, then my urologist gave me a prescription for lotrisone, that seemed to help a lot with my skin clearing, color normalizing and becoming more "elastic" and normal.  However, after using that, the rash all over scrotum has come back.  My dermatologist is not sure what it is but commented that the skin is thickening (he thinks either yeast or irritant dermatitis).  I have not been scratching at all.  The feeling is what I would describe as tightness and discomfort with a red rash with discrete borders throughout my scrotum.  The derm gave me a compound prescription of lotion with hydrocortizone powder and rubelon mixed in.  In two days of use, no improvement.  In two weeks, the derm will do a biopsy if needed.  Based on the information I have provided, can you help me with a potential diagnosis, prognosis and what you would recommend for treatment?  I am confused as sometimes you have indicated moisturizers only with molehair pad and other times cortisone.  Thanks for your help and guidance Doctor.  Could this be LSC?

[Alan Rockoff, MD]

Based on what you've told me, I think you had irritation which has left behind redness and that basically, you have nothing at all.  Your anxiety over an STD is understandable, but I hear no evidence that you have one.  After sensitive skin like skin on the scrotum is irritated, it stays red for a long time, and I've found that the best way to let it fade is to leave it alone and do nothing.  As for the sensations of tightness and elasticity that you're feeling, those I believe are from focusing on a problem that really isn't a problem.

Of course, you'll want to thin twice before engaging in the kind of behavior that's caused you so much anxiety.  But it sounds to me like you're OK and should just ignore the scrotum and move on.

Take care.

Dr. Rockoff

[zsolt]

You just described what I have been dealing with in the past several years. I am a research scientist in the area of family medicine. I have done an extensive literature research on this problem, since I suffer from it every day. I am not surprised that you hit brick walls with your condition. Based on what you (and others on this forum tell - please, read similar threads) you may have the "Red Scrotum Syndrome", or some suggested that it should be called the "male genital skin burning syndrome (Dysaesthetic Peno/Scroto-dynia)" based on a very similar condition found in women. There is a very limited medical literature on this problem, although experts in the area now accept that it exists.

Based on the lack of improvement in response to any conventional treatment option (steroids, antifungals, etc) on one hand, and the beneficial effect of SSRIs (anti-depressant and anti-anxiety drugs) and other drugs that can either locally or centrally interfere with the nervous system on the other had, it has been suggested that the origin of the problem is not dermatological, but neurological. The mechanism is unknown. Some studies have looked at a possible connection between this condition and a lot of sitting and/or local physical "stress", others suggested the involvement of the central nervous system and particularly anxiety.

There are some great suggestions on this forum about how to alleviate pain and suffering and what drugs can be effective in treating the symptoms (not the problem). Unfortunately no research is funded currently (according to my knowledge) and there is little medical "interest" to figure out what is going on and what we could do about it and the condition is very frequently mis- or under-diagnosed due to the lack of information. I have been thinking about taking up this problem (that I unfortunately own) and do a clinical trial in our research network to learn at least what helps with the symptoms and how much. Here are some MEDLINE references that once can start with:

Fisher BK.  
The red scrotum syndrome.
Cutis. 1997 Sep;60(3):139-41.  

Markos AR.
The male genital skin burning syndrome (Dysaesthetic Peno/Scroto-dynia).
Int J STD AIDS. 2002 Apr;13(4):271-2.


Zsolt

[dunno sumthin]

I want to really thank you for your helpful note back.  I am into this for a just a few months, but it has been really bothering me and I know it is not just about moving on.  My dermatologist is concerned and truly did not know exactly how to proceed.  I am going to have a biopsy completed and I will definitely share the outcome.

I truly have been confused as to whether I should be using a corticosteroid or not and is this something that I can just ride out and know it will eventually heal.  I think all I can do is trust my dermatologist and proceed with what he thinks is the best thing to do.  It does not appear the higher level cortizone cream is really helping.  The redness will subside however today it is back full force with the discomfort and burning feeling.  I do not think this is because I am "paying too much attention to it".  This is real and frustrating.  Would you mind passing on how I can access the complete articles your referenced?  I have seen the abstracts but would like to read more before my next appointment this Wednesday the 14th of February.

[freke70]

I have a similar problem, but I've not gotten it checked by a doctor yet. In my case, my scrotum itches a few times a day, and I usually scratch it. Sometimes it itches rather extremely. It's very dry and flakey. When it seems "healed," the area's skin seems thicker than it should be. The fact that it could be neurological makes so much sense to me, since my eyelids have exactly the same condition as my scrotum. I know it sounds weird, but my eyelids itch, and I scratch them sometimes, and they flake. when there's no dead skin on my eyelids, it seems like they are thicker than they should be. My eyelids have had this problem for about six months now, and the scrotum has been acting up for almost a year now. I've used various lotions on them, and sometimes petroleum jelly to relieve the itching. It only works for a couple hours at a time, though, which can be annoying. I'm very interested in hearing your biopsy results, so keep us updated.

[trastony]

A related discussion, scrotum sack itch was started.