Unrelenting Scrotum & Crotch Rash

[skin640]

Months ago, I began itching in my crotch.  I tried Tolnaftate, Miconazole, Clotrimazole, Terbinafine – no help. My skin got very red from the top of one thigh to the other and my scrotum was crimson red and burned.  I tried aloe.  I tried Neosporon.  I tried Hydrocortisone. I tried permethrin. After week 2 of the onset of this rash, nothing really changed anything, except for some strange reason Terbinafine made the "rash" spread and worsen.  I tried Pure Neem Oil - no impact.  I tried Tioconazole & Butoconazole.  I broke down and went to see my dermatologist.  She said, "Oh.  That's erythrasma."  She prescribed a 5 day course of Zithromycin and 2 wks Iodoquinol cream.  I was pleasantly surprised that the rash began to retreat from my thigh and crotch.  I then ran out of the cream.  Within 2 days, the rash was back in full force.  I called her instantly.  She couldn't see me for 3 weeks.  I went to a "doc-in-the-box".  She offered no diagnosis.  She merely wrote a 10-day course of doxycycline and Triamcinolone cream - no impact.  I called the dermatologist again.  She again said it'd be 3 weeks before she could see me.  I went to a urologist.  He took one look and said, "Contact Dermatitis."  I walked straight out of his office and drove directly to another "doc-in-a-box."  She came in and said, "That is a yeast infection."  She wrote a single pill dose of Diflucan and ketoconazole cream – no change.  I then finally decided to wait the 3 weeks and see the dermatologist again.  She said she thinks it's perhaps an extreme case of jock itch.  She prescribed oxiconazole cream.  She recommended that I order Triple Paste with Miconazole.  I went through all the Rx cream and tried a tube of the Triple Paste.  This time, it seemed that the oxiconazole improved things, but not to the extent that the Iodoquinol had, but nonetheless, the rash did not clear completely.  As soon as the Rx cream was gone, I applied Triple Paste.  Within 2 days, the rash was in full force again.

[willy851]

I suffered from the same thing. I went to many dermatologists and received the same bull as you have. Two said it was eczema, even though it didn't match any of the symptoms. The only thing I found that matched was red scrotum syndrome. The doctor said this wasn't a real diagnoses.
The only thing that worked was Vaseline after my shower. I would apply a thick coat on the area after every shower. The pain eventually got better. Now it pops up every once in a while. I am currently seeing a dermatologist from the University of Penn.
He doesn't know what it is either, at least he is working with me. He believes it is nerve related.

[moo99]

I have just posted this on another forum in reply to lamb72. I to have this and haven't managed to rid myself of it after 1 year. I have tried natural remedies without success and have also been put on doxycycline without joy. However, I have read studies in Middle East have been successful with this. I have also tried gabapentin but this had side effects and I had to stop. My dermatoligist thinks it may be either nerve or stress related.

[willy851]

I have found that the basic moisturizers worked the best. But if I used it to much that caused problems to. Cerave also worked well. The most important thing was not to apply any steroids or chemical moisturizers.  I proved to the doctor that I wasn't allergic or sensitive to steroids. They didn't work because it isn't eczema.
When I went to the University doc I showed them how it can turn deep red and burn like hell within a minute and go away within a few minutes.
There are actually hundreds of guys with this problem. look up chronic red burning scrotum.

[lamb72]

I to have what you have the Doc calls it Red Scrotum Syndrome or Scrotodynia or Red Bag Snydrome. He has taken a Biopsy and skin culture- results Fungus. This is going on over 1 year, he has given me almost everything that is available RX. He is now talking about nerve related. I just went to a spine Doc he is puzzled. He said that he would research it but don't think that is what is causing my problem.
I put a post up a week ago- no responce.
Lamb72

[skin640]

Hi Willy.

Thanks so much for the post.  It so good to hear someone sharing the frustration with me.  Actually, the last time I saw my dermatologist, she insisted it cannot be related to an infection b/c of the many antiinfectants that we've used systemically and topically, whether antibiotic or antifungal/yeast.  She too felt this had to be something neurological.  I find it interesting that both of our dermatologists are saying the same thing.  It is verrrry frustrating.  I think if nothing else, it is a testament to how far we've yet to go in the medical sciences.  I think whatever this is, very little is known about it, and it appears to be fairly rare, and since it is rare and since it isn't apparently directly hazardous or contagious, there is likely very little interest in this conidtion.

My condition remains the same now as it did several months ago.  There has been NO change at all.  I have a very red, very wrinkled (more than normal) scrotum that burns.  The only thing that ever changes is that the burning varies from time to time.  The only time it gets unbearable is when a chemical irritant worsens the pain, such as is my experience with Protopic (worst of all), "pure" Aloe Vera gel and a few others.  After applying the Protopic, I was in tears for the a long period of time.  I finally applied an ice pack, and the pain lessened.  I have also tried 4 or 5 topical analgesics, and these strangely worsen the pain instead of reducing the pain.  I have tried so many things.  I have even read or had people tell me to try Capsicum and Salicylic Acid, but this sounds very dangerous for an already sensitive area.  I am also yet to have tried the coal tar approach.  Right now, it seems StriVectin, oddly enough, improves at least the appearance -- reducing both the redness and wrinkling, but the effects are very modest and very temporary (a few hours improvement at best), and StriVectin is VERY expensive.  I have not tried Vaseline, though I have tried Aquaphor which I believe is essentially petroleum jelly with Chamomile.  Thanks for the tip.  I may try regular Vaseline.

[skin640]

The rash still persists to this day, and still no doc knows what it is.  I have seen 2 separate urologist, 2 GP's and 1 dermatologist.  I have seen the dermatologist 4 times and one of the GP's twice and the other GP 4 times.  Not once have any of them offered to do any "scrapings" or even any blood work or any kind of objective testing.  They insist on playing guess work.  I am not very medically estute (sp?), but I have remained appaulled by the fact that they simply look at it and guess and at this point are essentially saying they have no idea what it is or how to treat it and basically leave me hanging as if to say, "Oh well, you have a groody rotten scrotum.  Hate it for you.  Live with it."  I thought we lived in a medically advanced age.  It seems a skin rash should be fairly easy to properly diagnose and treat given all the technology and knowledge available today.  I do not know why the doctors will not take a skin sample for analysis.  I wish I could get someone to take this seriously.  I am considering going to see another dermatologist.  I may loose my job and insurance soon so I may be stuck to live with it.   It burns 24/7 and has for several months now, sometimes worse than others.

[memexxx]

why dont u just give ur skin scrapings for microscopy to a hospital through ur gp so they can determine ur condition  n u can treat it  instead of wasting ur time for eye examination with dermatologists who are bored with their jobs n dont really kierr??

[skin640]

Hi.  Thanks. It is great to hear from a professional on this topic.  One disappointing thing though is I had to abbreviate because I had ~ 6000 characters, and the system limits me to 2000.  Two things that I cut were a 10 day trial of Cipro from a "doc-in-the-box," and a 1 week period where I decided I was going to do nothing literally, thinking as you stated that I may just be irrittating the skin trying to treat the rash.  The triamcinolone was completely ineffective and was tried for 2 weeks.  Also, for some reason not entirely clear to me, I am a fan of hydrocortisone.  I have my whole life kept plain ole hydrocortisone lying around the house.  I mentioned trying hydrocortisone.  I have done so many times through the months of wrestling with this, perhaps 5 weeks into it and then likely another 5 weeks laters and in fact, the very day (yesterday) I composed this question on this site.  Again, I do not understand why I like to keep trying it even though it doesn't work, perhaps it is because it doesn't burn as do Neosporin, Aloe and apparently anything containing glycerin, large amounts of petrolatum and things containing dimethicone (not sure this is a universal law.  I've tried a handful of things containing these), and hydrocortisone certainly doesn't worsen things as terbinafine clearly did.  Not only have i tried merely leaving the area alone.  I have also tried basic moisturizers/dry skin lotions such as ones containing coco butter, shea butter, collagen, elastin, vitamins A, D & E, grape skin, witch hazel and alpha hydroxy.  Oh my, what a mistake the alpha hydroxy was --  PAIN!!!  Another interesting observation I have made is that the store commonly has hydrocortisone with aloe and vitamins A, D & E (at least my local Walgreens does).  One day I went in for more, they had a hydrocortisone cream with Chamomile.  As I have shared hydrocortisone and triamcinolone alone are utterly useless.  I have seen possible improvements from only 3 things -- Iodoquinol (unquestionable improvement but with very rapid return), Oxiconazole (mild improvement with rapid return) and hyrdocortisone with chamomile (mild improvement with rapid return).  (I've also gotten mixed results from Neem Oil.  The 1st use of it made no change.  Weeks later I tried again and saw improvement for the 1st 2 days of trying it.)  I've wanted more of this hydrocortisone with chamomile but have been unable to find it in the handful of stores I searched.  The Walgreens I'd origianlly gotten it from does not have it any more, nor do the other 2 walgreens in town.

Oh.  I also wish to share that this rash has not itched since the 1st month after the onset.  The bothersome aspect of the rash now is the burning, the sensitivity (to the aforementioned "chemicals" as well as to a touch which spreads the folds to allow inspection of how far reaching the redness is) and, strangely enough, the extreme wrinkles -- far worse than normal scrotum wrinkling.  In short, the burning, the hideousness and persistence of this are my principle complaints.

and oh, i've tried zinc oxide, preparation H (b/c it had hydrocortisone, and i didn't feel like going to the store at the time) and selson blue (my hairstylist shared a friend of her's son had a skin condition that was nonresponsive to everything in the world and her son's dermatologist recommended selson blue).  these do not help me either.

Thanks!

[Alan Rockoff, MD]

It seems pretty clear that you don't have a yeast or fungus infection, at least not any more.  You've used so many effective creams (and a pill) for that purpose that I can't imagine any of them are left alive.  I therefore suspect that you have a non-fungal rash in the seborrhea-psoriasis family.  But, as I often comment on this forum, I see many patients who prolong their problem by paying too much attention to redness.  After rashes go away in the groin, they often leave the skin looking very red--not forever but for weeks.  Putting medicated creams on this doesn't help and may even prolong the redness.  (Needless to say, rubbing and scratching does the same thing.)  Bottom line: you don't have some rare, serious disorder, just an annoying one.  Talk to your dermatologist about using a prescription-strength steroid for 10 days.  (You mentioned triamcinolone, which is one of these, but didn't say how long you used it.)  Then just wait for the redness to go away.  I am confident that it will, if you give it a chance.  If not, the dermatologist can perhaps consider a skin biopsy to help clarify the diagnosis, though I doubt one will be necessary.

Good luck.

Dr. Rockoff