Scrotal Skin Disorders
There are certain conditions that can be bothersome or simply worrisome to a man when it comes to his scrotum. These concerns may range from jock itch to infected hair follicles. However, any pain or swelling of the scrotum should be looked into more closely (click HERE to learn more about pain and swelling). This section will focus only on disorders that affect the exterior skin of the scrotum.
Scrotal dermatitis is an inflammation of the scrotal skin. It is often mistaken for jock itch because many of the symptoms are the same; however, it is not caused by a fungal infection. The symptoms of scrotal dermatitis include redness, itching, swelling, and even scaling of the scrotal skin. There are multiple causes for scrotal dermatitis, but the causes can be allergic in nature. Some of the most common allergic reactions can be caused by laundry detergent (on the underwear), soaps, spermacides (often from the bottom roll of a condom against the upper scrotum), or other products applied to the genitals during sexual relations such as lubricants, creams, lotions, etc. In some cases, what was thought to be a fungal infection is treated with an anti-fungal cream which some men may be allergic to. This worsens the inflammation and itching. Sweating in this area can open pores allowing irritants to enter into the scrotal skin more easily.
Scrotal dermatitis can also be caused by certain types of non-fungal infections, as well as other diseases such as Paget’s Disease or diabetes (to see a bump associated with Paget's Disease, click HERE). Scratching the skin can worsen the inflammation. There are four main types of scrotal dermatitis:
Mild acute dry – the skin is red and dry. Symptoms of severe burning and itching typically accompany this type of dermatitis. Often this resolves itself in a few weeks. Treating mild acute types of dermatitis usually involves stopping the use of products that may be causing the irritation. A steroid cream is often used for one week to help resolve the dermatitis.
Severe chronic dry – the scrotum can be bright red, have less color than normal, and/or be dry and scaly. Itching and burning accompany this type as well, and it can spread onto the thighs and lower shaft of the penis. It typically doesn’t go away quickly (hence the name chronic). Treatment can include giving oral antihistamines in addition to a low potency corticosteroid cream to reduce inflammation. In some cases, treatment with certain types of UV light can significantly help (this would need to be administered by a healthcare provider). To see an example, click HERE.
Chronic wet – the scrotum and inner thighs become wet and saturated as the area oozes. Oftentimes there is a strong odor and some painful sores.
Ulcerated and edematous – painful ulcerations. The scrotum itself is swollen and there is fluid oozing from the affected area. To see an example, click HERE.
Treatment for scrotal dermatitis includes wearing loose-fitting underclothing to allow the area to breath. Only a healthcare provider can recommend treatment options that will work for a specific type and cause of scrotal dermatitis. Seek the advice of a healthcare professional if you feel you have one of the above conditions.[i]
RED SCROTUM SYNDROME
This is an extremely rare condition that typically affects older men and can last for years. The disease is similar in how it looks to normal dermatitis – red, burning, itching --however, there is typically no scaling of the skin. There is often a very defined line between skin that is involved and skin that isn’t. Treatments may include antibiotics like doxycycline or other therapies. Seeking the medical attention of a healthcare provider is always wise in conditions affecting the genitals that don’t resolve on their own orby using over-the-counter treatments.[ii] To see an examples of Red Scrotum Syndrome click HERE.
BUMPS & INGROWN HAIRS
From time to time, especially during the early years of puberty when pubic hair is starting to grow, men may notice white bumps that look a little like pimples on their scrotum. These are often caused by folliculitis, an inflammation of the hair follicles.
During puberty, when new hair is developing and growing on the scrotum, the hair follicles can become clogged. Sometimes these infected hair follicles can be caused by a clogged sweat gland in the groin; so, keeping the area clean can help prevent folliculitis.
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769120/ (3/11/17)
[ii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184780/ (3/11/17)
During puberty, when new hair is developing and growing on the scrotum, the hair follicles can become clogged. Sometimes these infected hair follicles can be caused by a clogged sweat gland in the groin; so, keeping the area clean can help prevent folliculitis. In older teens and adults, scrotal folliculitis occurs most often if the scrotum is shaved. Shaving not only increases the risk of ingrown hairs, but it creates small nicks or cuts on the skin of the scrotum that can become infected. Ingrown hairs occur when a hair tries to grow back out of a follicle, but because it doesn’t already have a head start out of the skin it can sometimes start growing into the skin leading to inflammation. These often resolve, especially when shaving stops altogether. In some cases they may require the intervention of a healthcare professional to resolve. Hair trimming is a personal choice, but shaving of the scrotum is not recommended due to the high risk of cutting the sensitive and extremely thin scrotal skin. If a man desires less scrotal hair, trimming the hair to shorter lengths rather than shaving is recommended to prevent folliculitis and cuts. More information on folliculitis and ingrown hairs click HERE.
Another type of raised, typically clear/off white bumps are Fordyce spots. These can occur on the scrotum, penis, or lips. These are often small, raised, white dots that don’t hurt or itch. There is no need for treatment and oftentimes they go away on their own. To see an example of a fordyce spot on a scrotum, click HERE.
Red bumps on the scrotum are sometimes caused by small bumps full of blood. These sometimes bleed and can be problematic. Oftentimes this condition is called Scrotal Angiokeratosis. To see and example of scrotal angiokeratosis, click HERE.
Sweat glands that produce a waxy substance known as sebum are often found next to hair follicles. Sebum is what gives white undershirts their classic “yellowing stains.” These sweat glands (called sebaceous glands) near scrotal hair follicles can become clogged with sebum and form cysts. If there is only one cyst, it is commonly called a sebaceous cyst. However, when multiple glands become clogged they are known as pilar cysts or trichilemmal cysts. To see an example of pilar cysts, click HERE. Treatment for a single cyst may consist of watching and waiting. For multiple cysts or very large cysts, antibiotics are administered to kill bacteria that grow easily in sebum. In some cases, treatment may involve having a healthcare professional drain and clean the cyst in addition to antibiotics.
SORES & WARTS
Sores or warts can appear on the scrotum. These are often linked with sexually transmitted infections like genital herpes and genital warts (click HERE to learn more). These sores or warts are more commonly found on the penis than the scrotum. However, when these appear on the scrotum it will usually be in the area closest to the penis. These require treatment from a healthcare professional.
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