Added: Deon Halle - Date: 28.09.2021 01:19 - Views: 24720 - Clicks: 7490
Try out PMC Labs and tell us what you think. Learn More. Red scrotum syndrome is a rare and chronic disease affecting males in their second half of life. It is characterized by erythema with sharpborders, no scaling but burning and pain sensations.
We report about two cases treated successfully with either doxycycline and tacrolimus or gabapentine. For practical purposes we suggest to start treating red scrotum syndrome with doxycycline for 2 weeks and use gabapentin as second-line treatment when doxycycline fails.
The genital skin Dick is hot red be affected by many of the classical inflammatory dermatoses like atopic and irritant dermatitis, psoriasis or ichthyosis. One of this is the Red Scrotum Syndrome RSS that affects males in their second half of life and typically runs a chronic course. Delayed diagnosis ificantly contributes to ineffective treatments.
A year-old man presented to our department because of persistent redness of the scrotal skin and the base of the penis for about two years. He had suffered from severe itching intertriginous eczema and anal pruritus with anal fissures for more than 20 years. He had been treated with topical corticosteroids Dick is hot red topical antimycotics.
Because of the chronic anal fissuring he was treated with botulinum A injections in the anal spincter and surgical fissure ectomy. He was taking an oral statin to control hypercholesterinemia for several years. On examination we found a healthy man with a highly erythematous scrotal skin without any ificant scaling, infiltration or lichenification. There was a sharp border to the adjacent unaffected skin [ Fig. On the inner thighs striae were present due to long-term steroid application.
Red scrotum syndrome. A Sharp border between intense erythematous scrotal skin and adjacent skin. No scaling. B Less intense redness on the posterior site. A patch test was performed to exclude a contact dermatitis due to topical medical drugs, emulsifiers and preservatives without any positive result. Mycological investigations were negative. We made the diagnosis of RSS. He was given topical corticosteroid ointments without improvement.
Even two courses of systemic corticosteroids did not improve the situation. There was an improvement of the erythema after several weeks due to topical calcineurin inhibitor pimecrolimus. The burning and sometimes itching sensations and the hyperalgesia the patient experienced did not improve much. After 4 months, however there was a relapse that could not be controlled by pimecrolimus ointment anymore.
Oral doxycycline for 4 weeks did not result in any improvement. Therefore, treatment was switched to oral gabapentine. After 2 weeks a partial remission was noted and further improvement was observed during the next 2 months. A year-old man presented with burning sensations of scrotal skin for at least 12 months. Topical treatment with corticosteroid ointments so far had not improved his complaints. On examination we found an erythematous scrotal skin without any scaling or scratch marks. The border to the adjacent skin was sharp. He was otherwise healthy.
A diagnostic biopsy was taken that was unremarkable beside superficial telangiectasias. The diagnosis of RSS was made. We started treatment with doxycycline p. The redness also improved markedly within 10 days.
After 4 weeks treatment was stopped because of complete remission. Both patients reported lower back pain and lumbago in the past but they did not connect these complaints to the scrotal skin affection. RSS is a rare disease characterized by persistent redness of the anterior half of the scrotum and may involve the base of the penis as well. It is accompanied by itching, burning and pain sensations. The major symptoms are neurological. Despite looking like eczema on a first glance, morphology and course is quite different. Itch is not the predominant subjective symptom but burning and hyperalgesia.
This argues for a possible neurogenic inflammation. Indeed, RSS resembles erythromelalgia. Thompson's criteria for this complaint are as follows: 1 burning pain of the extremities; 2 pain aggravation by warmth; 3 pain relief by cold; 4 erythema of affected skin; 5 increased temperature of the skin. For decades, there was no effective treatment available.
We observed some improvement due to topical calcineurin inhibitors but could not control the burning and pain sensations. Recently, two quite different treatments have been reported with improvement of RSS: oral doxycycline and oral gabapentine. Doxycycline is a tetracycline with antibiotic and anti-inflammatory effects. It can inhibit matrix metalloproteinases and thereby preventing tissue destruction. In retrospective evaluation of a group of seven patients, oral doxycycline and steroid abstinence resulted in complete resolution within 2 to 3 months.
First improvement was noted within the first two weeks. We used doxycline in the first place for patient 1 and observed no improvement. Treatment was switched to oral gabapentine. After 2 weeks a mild improvement was noted, treatment is continued. For practical purposes we suggest to start with doxycycline for 2 weeks Dick is hot red use gabapentin as second-line treatment when doxycycline fails.
National Center for Biotechnology InformationU. J Dermatol Case Rep. Published online Sep Uwe Wollina. Author information Article notes Copyright and information Disclaimer. Corresponding author: Prof. E-mail: ed. Received Dec 13; Accepted Feb This article has been cited by other articles in PMC. Abstract Background Red scrotum syndrome is a rare and chronic disease affecting males in their second half of life. Main observations We report about two cases treated successfully with either doxycycline and tacrolimus or gabapentine.
Conclusion For practical purposes we suggest to start treating red scrotum syndrome with doxycycline for 2 weeks and use gabapentin as second-line treatment when doxycycline fails. Keywords: differential diagnosis, doxycycline, gabapentine, neurogenic inflammation, red scrotum syndrome. Introduction The genital skin can be affected by many of the classical inflammatory dermatoses like atopic and irritant dermatitis, psoriasis or ichthyosis. Case Report CASE 1 A year-old man presented to our department because of persistent redness of the scrotal skin and the base of the penis for about two years.
Open in a separate window. Figure 1. CASE 2 A year-old man presented with burning sensations of scrotal skin for at least 12 months. Discussion RSS is a rare disease characterized by persistent redness of the anterior half of the scrotum and may involve the base of the penis as well. Table 1 Differential diagnosis of Red Scrotum Syndrome.
References Kantor GR. What to do about pruritus scroti. Postgrad Med. Fertil Steril. Nine male cases of tinea genitalis. The red scrotum syndrome. Clin Orthop Relat Res. Red scrotum syndrome: successful treatment with oral doxycycline.
J Dermatolog Treat. Case report: red scrotal syndrome: a localized phenotypical expression of erythromelalgia. J Drugs Dermatol. Tetracyclines: A pleitropic family of compounds with promising therapeutic properties. Review of the literature. Am J Physiol Cell Physiol. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. J Support Oncol. Non-hormonal treatment strategies for vasomotor symptoms: a critical review.
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Red scrotum syndrome