From the Guidelines
Scrotal pruritus is most commonly caused by fungal infections, contact dermatitis, excessive sweating, poor hygiene, or occasionally parasites like scabies, and its management should prioritize keeping the area clean and dry, using over-the-counter antifungal creams, and wearing loose-fitting cotton underwear. When considering the causes of scrotal pruritus, it's essential to look at the broader context of generalized pruritus, as the specific causes of scrotal itching can be related to systemic conditions. According to the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1, several potential underlying causes should be considered, including iron deficiency, iron overload, blood disorders, malignancy, endocrinopathy, uraemia, liver disease, neuropathy, infections, and infestations. However, the most recent and highest quality study directly related to scrotal pain and potentially relevant to scrotal pruritus, from the Journal of the American College of Radiology 1, highlights the importance of diagnosing acute scrotal conditions such as testicular torsion, torsion of the testicular appendage, and epididymoorchitis, which can present with pain and potentially itching due to inflammation.
Key considerations for managing scrotal pruritus include:
- Keeping the area clean and dry to prevent fungal infections
- Using over-the-counter antifungal creams for suspected fungal infections
- Applying 1% hydrocortisone cream sparingly for inflammation
- Wearing loose-fitting cotton underwear to reduce moisture and friction
- Avoiding scratching to prevent worsening symptoms and secondary infections
Given the potential for underlying systemic conditions, a thorough history and physical examination are crucial, and investigations should be tailored based on clinical suspicion, as suggested by the guidelines for generalized pruritus 1. If symptoms persist or worsen, a healthcare provider should be consulted for further evaluation and potential prescription medications. The management of scrotal pruritus should prioritize reducing discomfort, preventing complications, and addressing any underlying conditions that may be contributing to the itching.
From the Research
Causes of Scrotal Pruritus
The causes of scrotal pruritus (itching) can be attributed to various factors, including:
- Inflammatory disorders 2
- Infections, such as bacterial and fungal infections 2, 3
- Infestations 2
- Neoplasms 2
- Chronic topical steroid use in the male genital area, which has been associated with Red Scrotum Syndrome (RSS) 4
- Scrotal dermatitis, which can be caused by various etiological factors, including contact dermatitis 5
- Scrotal pyoceles, which can cause testicular pain, swelling, and itching 6
Specific Conditions
Certain conditions can also contribute to scrotal pruritus, such as:
- Red Scrotum Syndrome (RSS), characterized by scrotal erythema, burning sensation, pain, hyperesthesia, and pruritus 4
- Scrotal dermatitis, which can be mistaken for other skin disorders, such as fungal infections 5
- Penile dermatophytosis, a rare condition caused by Trichophyton rubrum 3
- Scrotal pyoceles, which can be treated with broad-spectrum antibiotics and observation, or surgical drainage if necessary 6