A 38-year-old man presents complaining of incessant burning and itching of his scrotum. The condition has been present for several months and was diagnosed elsewhere as a yeast infection. Oral fluconazole had no effect, and topical econazole caused increased irritation and could not be tolerated. The patient denies a history of diabetes or sexually transmitted disease. He admits to increased anxiety of late and was recently prescribed alprazolam. Examination of his scrotum reveals diffuse erythema with scant lichenification. Slight erythema at the base of the penis is also noted. No nits or crab lice are detected.
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Red scrotal syndrome was first reported in 1997 by Fisher,1 who described cases characterized by persistent erythema of the scrotum accompanied by itching, burning, and hyperalgesia. The redness is well-demarcated, and there is no scale or lichenification.
The majority of patients with the condition are aged older than 50 years. The etiology is unknown, and the condition is hypothesized to be a form of primary erythromelalgia.2 Patients commonly report worsening following the use of over-the-counter or prescriptive topical steroid medications.
The majority of symptoms are neurologic, and treatment with gabapentin may be effective.2,3 Several case reports also document improvement with doxycycline.4,5 Topical steroid medications exacerbate the condition and are best avoided.
Stephen Schleicher, MD, is an associate professor of medicine at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Fisher BK. The red scrotum syndrome. Cutis. 1997;60:139-141.
- Prevost N, English JC 3rd. Case report: red scrotal syndrome: a localized phenotypical expression of erythromelalgia. J Drugs Dermatol. 2007;6:935-936.
- Wollina U. Red scrotum syndrome. J Dermatol Case Rep. 2011;5:38-41.
- Abbas O, Kibbi AG, Chedraoui A, Ghosn S. Red scrotum syndrome: successful treatment with oral doxycycline. J Dermatolog Treat. 2008;19:1-2.
- Byun JW, Hong WK, Han SH, et al. Red scrotum syndrome: successful treatment with oral doxycycline. Int J Dermatol. 2012;51:362-363.