DermDx: Burning Rash on Scrotum

DermDx: Burning Rash on Scrotum

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A 62-year-old man presents to the clinic with complaints of burning and itching of his scrotum that began several months ago. He initially self-medicated with over-the-counter hydrocortisone and anti-itch creams, which were not effective. A medical provider at an urgent care center diagnosed a fungal infection and he has been on oral terbinafine and clotrimazole for 3 weeks without improvement. The patient is in good health and takes no oral medications. He states that the condition is contributing to increased anxiety and social isolation. Physical examination reveals erythema of the anterior scrotum with absence of lichenification and scale.

Burning scrotum syndrome, also referred to as red scrotal syndrome and male genital dysesthesia, was first described by BK Fisher, MD, who reported 2 cases in 1997.1 The patients had persistent erythema of the scrotum accompanied by a burning sensation,...

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Burning scrotum syndrome, also referred to as red scrotal syndrome and male genital dysesthesia, was first described by BK Fisher, MD, who reported 2 cases in 1997.1 The patients had persistent erythema of the scrotum accompanied by a burning sensation, a feeling of heat, and hyperalgesia. One patient admitted to suicidal ideation and had consulted several dermatologists. Both patients had received multiple topical and oral medications without improvement. One of the patients was treated with pimozide, an antipsychotic used to treat delusions of parasitosis.1

The condition classically presents with sharply defined erythema primarily of the anterior scrotum with occasional extension onto the base of the penis. Scaling and excoriations are not observed and histopathology reveals no specific findings. The etiology is uncertain; prolonged use of topical steroids and use of harsh soaps may be contributory. The condition has been likened to a form of primary erythromelalgia.2

Small case reports of burning scrotum syndrome document improvement with a variety of oral medications including gabapentin and pregabalin.2,3 In one study, patients responded to treatment with doxycycline combined with corticosteroid abstinence.4 More recently, Hwang et al noted response to oral indomethacin.5

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Fisher BK. The red scrotum syndrome. Cutis. 1997;60(3):139-141.

2. Prevost N, English JC 3rd. Case report: red scrotal syndrome: a localized phenotypical expression of erythromelalgia. J Drugs Dermatol. 2007;6(9):935–936.

3. Miller J, Leicht S. Pregabalin in the treatment of red scrotum syndrome: a report of two cases. Dermatol Ther. 2016;29(4):244-248. doi: 10.1111/dth.12354

4. Abbas O, Kibbi AG, Chedraoui A, Ghosn S. Red scrotum syndrome: successful treatment with oral doxycycline. J Dermatolog Treat. 2008;19(6):1-2. doi:10.1080/09546630802033858

5. Hwang AS, Costello CM, Yang YW. Rapid improvement of burning scrotum syndrome with indomethacin. JAAD Case Rep. 2021;12:32-33. doi:10.1016/j.jdcr.2021.03.050

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