What is Scrotal Eczema?
Scrotal eczema is a type of eczema that affects your scrotum. Skin, which is affected by eczema, starts producing less oil and fat as compared to healthy skin. When this happens, the skin begins to hold less water in, leading to gaps that start opening up between the skin cells. These gaps then allow irritants and bacteria to penetrate the skin easily, causing different types of problems.
There is a lot of debate on whether scrotal eczema is a different condition than eczema that occurs in other parts of the body. For example, research that was done by the Department of Dermatology, Venereology, and Leprosy at MGIMS in India, argued that scrotal eczema should be classified separately.(1)
Scrotal eczema is known to share many of the same symptoms as eczema that is found on other parts of the body. Let’s take a look at the symptoms of scrotal eczema and what you can do to treat and manage this condition.
Symptoms and Complications of Scrotal Eczema
In most cases, people end up mistaking scrotal eczema for some other skin condition, such as a fungal or yeast infection. Due to this reason, it is essential that anyone who is experiencing the symptoms of scrotal eczema should consult a skin specialist or a dermatologist at the earliest to get the right diagnosis.
You might notice that in mild cases of eczema, the affected part of the skin will become itchy, red, dry, and sometimes even scaly.
In severe cases of eczema, you might notice bleeding, crusting, and even weeping of sores. Scratching the itchy skin will only make the condition worse, causing the wounds to open up and increasing the risk of infection.(2)
A dermatologist will be able to determine the exact seriousness of the condition, identify the underlying triggers, and also diagnose the underlying form of eczema.
There are four classification categories of scrotal eczema that were identified in 2013. These include:
Type 1 – Mild, Dry, Acute Scrotal Eczema
In type 1 scrotal eczema, the skin looks red and irritated. There is a clear visual difference between the affected skin and healthy skin. The affected skin will also itch severely, and you will feel it stinging.
Mild, acute, and dry scrotal eczema can last for a couple of days to a couple of weeks, and in some cases, the symptoms end up clearing up on their own.
Type 2 – Severe, Chronic, and Dry Scrotal Eczema
In type 2 of scrotal eczema, the skin of the scrotum starts to appear scaly. It turns either bright red or even become unnaturally pale and takes on a scaly appearance. The thighs and the skin under the penis might also become affected. You will feel a severe burning and itching sensation in type 2 scrotal eczema as compared to type 1 eczema.
Type 3 – Chronic and Wet Scrotal Eczema
The entire scrotum, as well as the inner sides of your thighs, appear to be soft and moist, and there is fluid oozing from the general area. Blood vessels can also seem to stick out in a spider vein pattern, and there can also be a bad smell emanating, and painful sores are also common.
Type 4 – Swollen Ulcers in Scrotal Eczema
This is the most severe type of scrotal eczema. In this form of scrotal eczema, the skin of the scrotum becomes swollen, and pus and fluid are oozing out from the open wounds and ulcers. There is a bad smell that emanates from the wounds, and the stage is known to be extremely painful. In some extreme cases, gangrene starts to set in and spreads slowly to the lower abdomen and even the legs.(3)
The issue with diagnosing scrotal eczema is that scrotal eczema is not a stand-alone condition. In fact, in two cases, what was believed to be an apparent case of scrotal eczema, actually turned out to be a form of syphilis. These cases were discovered in 2007 by researchers from the College of Medicine at the Catholic University of Korea.
The researching team who diagnosed the condition noted that they were not aware of this type of presentation before these cases were diagnosed.
In some rare cases, researchers have also noted that extra mammary Paget’s disease of the scrotum can also be mistaken for scrotal eczema and this requires proper medical screening to identify and treat the condition.
Many times, doctors also mistake scrotal eczema for being a common fungal yeast infection. Fungal yeast infections also cause irritation and itching in the groin region, but they require a different form of treatment as compared to scrotal eczema.
Due to the fact that scrotal eczema shares its symptoms with many such conditions, it is essential that people consult a doctor at the earliest to get an accurate diagnosis so that the correct treatment can be started.(4)
Causes of Scrotal Eczema
The exact cause of scrotal eczema is not entirely understood, but the underlying cause depends a great deal on the form of eczema you have. Since the skin of the scrotum is much more absorbent than the rest of your skin, it increases the area’s vulnerability to irritants and toxins that cause eczema.
Eczema also tends to have a family history. You are more likely to develop scrotal eczema if there is a family member who also has it. Some other types of skin conditions, such as other forms of eczema, might also cause scrotal eczema.
Some of the other risk factors that might cause scrotal eczema include:
- Skin infections
- History of asthma or allergies
- Stress and anxiety – these are known triggers of eczema
Diagnosis of Scrotal Eczema
Your doctor will begin the diagnosis of eczema by first looking at the rash. If you have had prolonged or severe flare-ups of scrotal eczema, you need to see a dermatologist who specializes in treating skin diseases.
Your doctor will begin by examining the affected skin and might also scrape off a small sample of the skin. The skin sample will be sent to a laboratory to identify the underlying source of the rash.
Treatment of Scrotal Eczema
Treatment of scrotal eczema is focused on stopping the itching. Your doctor is likely to recommend the one or more of the following treatment options:
- Corticosteroid injections that are used for severe eczema that cannot be controlled by other creams
- Over the counter corticosteroid creams or prescribed corticosteroid creams that are stronger
- Anti-anxiety medications to stop the itching
- Absorbent powders such as pramoxine topical (brand name Gold Bond)
- Steroid-free anti-inflammatory drugs such as tacrolimus (brand name Protopic) ointment and pimecrolimus (brand name Elidel) cream. Both medications will suppress the immune system response.
- Ultraviolet B (UVB) radiation therapy
- Over-the-counter antihistamines
- Medications that are prescribed for secondary infection, such as staph and fungal infections
People who have scrotal eczema tend to experience periods of remission followed by flare-ups. There is no cure for scrotal eczema, but it is possible to lower the frequency and severity of eczema flare-ups by taking preventive measures and following your doctor’s instructions.
Here are some tips you can use to lower your risk of flare-ups:
- Avoid scratching and use cold compresses to decrease the urge to scratch the area.
- Cut your fingernails and keep them short with no rough or jagged edges.
- Wear loose clothes, ideally made of natural and breathable fabrics like cotton. Wearing boxers over briefs will help prevent the area from becoming warm and moist.
- Use moisturizers
- Do not use harsh detergents, soaps, or products that contain fragrances
- Avoid extreme temperatures. Sweating in the heat or dry skin in the winter can worsen scrotal eczema
- Avoid having foods you are allergic to.
- Reduce your stress levels by practicing some stress-reduction techniques
- Opt for using hypoallergenic detergents.
- Krishnan, A. and Kar, S., 2013. Scrotal Dermatitis-Can we Consider it as a Separate Entity?. Oman Medical Journal, 28(5), p.302.
- Raynolds, A.H., 1967. Scrotal Dermatitis. JAMA, 199(4), pp.283-283.
- Mdedge.com. (2019). Man, 32, With Severe Scrotal Pain and Swelling. [online] Available at: https://www.mdedge.com/clinicianreviews/article/145263/mens-health/man-32-severe-scrotal-pain-and-swelling [Accessed 16 Jun. 2019].
- Baker, H., Ive, F.A. and Lloyd, M.J., 1969. Primary irritant dermatitis of the scrotum due to hexachlorophene. Archives of dermatology, 99(6), pp.693-696.
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