What is scrotal eczema?

By Dan Wessels

Reviewed by Stacy Sampson, DO

Eczema is a non-contagious, itchy, and dry skin condition that affects individuals differently. There are many forms of eczema that have different underlying causes. Scrotal eczema is a form of eczema that affects the scrotum, the bag of skin containing the testicles.

Skin affected by eczema may produce less fat and oil than healthy skin. If this occurs, the skin will hold less water in, causing gaps to open up between the skin cells. These gaps allow bacteria and irritants to penetrate more easily and cause problems.

There is some debate about whether the condition is separate from eczema that occurs in other parts of the body. One 2013 article, for example, argues that it should be classified separately.

Scrotal eczema shares some of the same symptoms as eczema found elsewhere on the body. In this article, we look at these symptoms, along with steps to help treat and manage the condition.

Symptoms and complications

Scrotal eczema can sometimes be mistaken for other skin conditions, including fungal (yeast) infections.

For this reason, it is essential that anyone experiencing symptoms should see a skin specialist to ensure an accurate diagnosis.

In mild cases of eczema, the affected skin will be red, itchy, dry, and scaly.

More severe cases can include bleeding, crusting, and weeping of sores. Scratching of the itchy skin can also open up sores, which are at risk of infection.

A skin specialist will be able to judge the seriousness of the condition, identify the potential contributing triggers, and diagnose the underlying type of eczema.

The 2013 review lists four potentially useful classification categories for scrotal eczema:

Type 1 — mild, acute, dry

The skin appears reddened and irritated, with a clear visual difference between the healthy and affected skin. The affected skin will itch severely and sting.

Mild, acute, dry eczema may last a few days or weeks, and the symptoms may clear up on their own.

Type 2 — severe, chronic, dry

The scrotum appears scaly, and either bright red or unusually pale with a scaly appearance. The thighs and skin under the penis may also be affected.

The burning and itching sensation is more severe in this type of scrotal eczema than in the mild, acute, dry type.

Type 3 — chronic, wet

The whole scrotum and inner sides of the thighs appear soft and moist, with fluid oozing from the area.

Blood vessels can seem to stick out in a "spider vein" pattern, and a bad smell and painful sores are common.

Type 4 — swollen, ulcers

The skin of the scrotum is swollen, with fluid and pus oozing from open wounds and ulcers that smell bad. This stage is extremely painful.

In extreme cases, gangrene sets in and spreads to the legs and lower abdomen.

Similar or related conditions

Scrotal eczema is not always a stand-alone condition.

For example, a 2007 study identified two cases of apparent scrotal eczema that were in fact forms of syphilis. The researchers noted that they were not aware of any such presentations before these two cases.

Researchers have also noted that extramammary Paget's disease of the scrotum — a rare but serious condition — is often mistaken for eczema and requires proper medical screening to identify.

Doctors may also mistake scrotal eczema for common fungal yeast infections. These conditions also cause itching and irritation around the groin, but they require different treatments.

Due to shared symptoms with these conditions, it is important for people to see a doctor for an accurate diagnosis.

Causes and risk factors

There are various proposed causes and risk factors for scrotal dermatitis. These include the following:

• Psychological stress: Stress can cause an itching sensation in the scrotum, which then creates a vicious cycle of scratching, skin damage, and itching.
• Continuous exposure to heat and humidity: Such as in tropical or industrial areas; wearing thick clothing can also cause symptoms.
• Exposure to certain irritant substances: These substances include grease, diesel, and dye in clothing.
• Reaction to over-the-counter drugs: These drugs can include topical antibacterials, such as neomycin and gentamicin.
• Skin irritation caused by condoms: This can be caused by the rubber in itself or nonoxynol spermicide.
• Lack of specific nutrients: These nutrients include zinc and riboflavin.
• Other health conditions: Including HIV and other types of infection.

Specific genes may also make people more prone to eczema. A 2017 study found a link between the genes that cause asthma, hay fever, and eczema.

Treatment

The primary treatment for scrotal eczema is to remove the sources of the irritation. This could mean wearing loose clothing, immediately stopping the use of any offending over-the-counter medication, and having counseling to deal with stress.

A doctor may also prescribe steroid creams, antihistamines, and moisturizers. Research has been conducted to find out which options are most effective.

Other studies have also found that ultraviolet (UV) ray therapy is effective in treating moderate to severe cases of eczema.

Prevention and management

Boxer shorts on washing line outside blowing in the wind.

Wearing loose clothing, such as boxer shorts, may help to prevent the scrotal area from becoming warm and humid.

Preventing scrotal eczema is mainly a matter of avoiding the different risk factors and sources of irritation that can trigger a flare-up.

Steps to take include:

• wearing clothing that allows good air circulation around the testicles
• avoiding over-the-counter topicals that cause skin irritation
• getting the right balance of vitamins and minerals in your diet
• avoiding exposure to dangerous chemicals and substances
• avoiding substances or materials that trigger an allergic reaction

Keeping the groin clean is crucial. People should dry the area thoroughly but gently after each wash to help prevent or manage the issue if eczema has developed.

It is essential that people with scrotal eczema avoid scratching their testicles.

If someone is using steroid cream to treat their eczema, they should wait until the cream is thoroughly dry before having sex. Some condoms and spermicides may irritate the skin. If these do cause a problem, a doctor can suggest an alternative to use.

People should visit their doctor if they experience any signs of irritation. Doing so can help to avoid a worsening of eczema symptoms, and this could also uncover an underlying related medical condition.

Outlook

Scrotal eczema, like eczema found elsewhere on the body, tends to be triggered by various irritants coming into contact with the skin.

Irritants can include heat and humidity, over-the-counter products that cause irritation or an allergic reaction, and contraceptives, such as condoms.

Some researchers think that there is a genetic reason for eczema. If someone develops problems with eczema, it is likely that they will experience multiple episodes in the future if they reintroduce any of the irritants that cause eczema.

Often, people can treat mild forms of scrotal eczema with a mild, topical steroid cream. Sometimes, however, the symptoms can disappear on their own once irritants are removed.

More severe cases will require a doctor to prescribe medicine and treatments, including specific steroids, antihistamines, moisturizers, and possibly UV ray therapy.

Scrotal eczema may progress from mild to more serious stages quickly if it is not dealt with appropriately. Scrotal eczema may also be a symptom of a more serious underlying health condition. People should arrange to see a doctor as soon as they notice symptoms appearing.

SOURCE: MEDICAL NEWS TODAY