A 70-year-old man comes to the office because he is concerned about purplish scrotal lesions. These are asymptomatic and “possibly present for several years.” His medical history is positive for hypertension, for which he currently takes hydrochlorothiazide. On physical examination, scattered violaceous papules, each measuring about 1 mm in diameter, are scattered on the scrotum, which has a reddish tinge. No similar lesions are noted elsewhere.
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Angiokeratoma of Fordyce presents with small hemangiomas, ranging from 1 to 2 mm in diameter. The papules are red or purple and may be associated with generalized scrotal redness.1 Angiokeratoma of Fordyce often presents in the second or third decade of life but is most common in older men.2
The lesions are believed to be triggered by elevated venous pressure. Scrotal angiomas may be associated with an inguinal hernia, varicose veins of the leg, or a varicocele.3
No treatment is necessary, and patients should be reassured that the hemangiomas are benign. If desired, shave excision, cautery, laser ablation, or fulguration can be performed to remove the lesions.4
John Pappas is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College 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.
- Miller C, James WD. Angiokeratoma of Fordyce as a cause of red scrotum. Cutis. 2002;69:50-51.
- Ribeiro S, Ferreira S, de Oliveira MC. A giant angiokeratoma of Fordyce: an uncommon cause of acute scrotum. BMJ Case Rep. 2013;2013.
- Vascular tumors and malformations. In: Habif TP, Campbell JL, Chapman MS, Dinulos JGH, Zug KA. Skin Disease: Diagnosis and Treatment. 3rd ed. New York, NY: Elsevier Saunders; 2011:536-561.
- Zeng Y, Li XQ, Lin QZ, Zhan K. Treatment of angiokeratoma of Mibelli alone or in combination with pulsed dye laser and long-pulsed Nd:YAG laser. Dermatol Ther. 2014;27;348-351.