By Gary M. White, MD
This middle-aged man had an itchy scrotum. Triamcinolone and not scratching fixed the problem.
One subset of a groin rash is the isolated, red scrotum. Possible causes are listed below.
The normal variant is most commonly seen in lighter-skinned patients, e.g., Fitzpatrick skin type I.
See psoriasis, groin.
Candida and/or some bacteria can cause a localized infection that turns the scrotum red.
The red scrotum syndrome or "rosacea of the scrotum" is characterized by a chronically red and itchy scrotum, flaring or at least lack of response to topical steroids, and clearing with avoidance of all topical steroids and oral doxycycline for 3-6 weeks [Int J Dermatol. 2012 Mar;51(3):362-3].
One report proposed that in some cases a primary irritant contact dermatitis from urine may cause a red scrotum [Cutis 1997;60;139].
Redness, crusting, and lichenification of the scrotum are reported to occur in riboflavin (vitamin B2) deficiency. Levels of other B vitamins and zinc may also be checked [JAAD 1992;21;15].
A red, tender scrotum occurred in a patient with Crohn's disease and zinc deficiency [BJD 1993;129;501(CP)]. Oral zinc sulfate rapidly cleared the eruption.
When the pruritus is significant and all other causes have been excluded, a neuropathic origin should be entertained. For these, oral gabapentin or pregabalin may be beneficial [Dermatol Ther. 2016 Apr 17].
In general, treatment is not needed unless pain, burning, itch or other symptoms are bothersome.
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