Scrotal eczema, also known as scrotal dermatitis, is a form of eczema that affects the sac of skin containing the testicles (scrotum). Eczema (atopic dermatitis) that affects the scrotum can be uncomfortable and frustrating. You may even feel embarrassed or uncomfortable discussing scrotal eczema with your doctor. Keep in mind, however, that this is a common condition. In fact, more than 750 male members of MyEczemaTeam report that eczema has affected their genitals.
If you have scrotal eczema, you don’t have to suffer through burning, itching, or general discomfort. Although there is no cure for eczema, scrotal dermatitis can be treated, and its symptoms can be managed.
It is important that you talk to your doctor or a dermatology specialist if you notice any new symptoms or changes in the appearance of your scrotum. Not only will they be able to manage your eczema symptoms, but they will also be able to rule out any other potential causes — such as fungal or bacterial infections and sexually transmitted infections (STIs).
Scrotal eczema is one type of genital eczema — a form of atopic dermatitis that can affect the scrotum, as well as the penis, foreskin, groin (the area where the upper thigh creases against the stomach), and the skin between the buttocks and around the anus (referred to as perianal eczema). Medical consensus does not consider scrotal dermatitis to be a separate disease on its own. However, some researchers have argued for differentiation between scrotal eczema and eczema that appears on other parts of the body.
Eczema that affects the scrotum most commonly causes intense itching and burning sensations. The skin of the scrotum also becomes scaly, discolored, and lichenified (thick and toughened). This appearance is what gives scrotal eczema one of its common names, “wash leather scrotum.” The “itch-scratch cycle”— in which scrotal inflammation leads to itching, and scratching this itch worsens the inflammation and eczema symptoms — is often responsible for this discoloration and lichenification.
Researchers have classified scrotal eczema into four different types based on severity and symptoms.
One study from 1990 found an association between scrotal eczema and infertility in males. According to the study, increased blood flow (hyperemia) and thickening of the skin on the scrotum caused the testicles to overheat. Heat stress can damage sperm. Treating the underlying eczema was found to improve sperm counts and sperm motility in the majority of the 16 participants.
In many cases, scrotal eczema is caused by a number of factors. Some forms of the condition are triggered by environmental factors, such as soaps, detergents, or allergens (such as pollen or animal dander). What’s more, several different types of eczema can affect the scrotum.
Stress has been found to play a key role in the development of eczema on the scrotum. When stress leads to an itching sensation, scratching this itch results in a psychological feeling of relief. This rewarding sensation thus leads to further scratching, which can, in turn, worsen eczema symptoms. This cycle continues to worsen the condition until this itch-scratch cycle is broken.
Scrotal skin affected by eczema becomes inflamed. Inflamed skin is more permeable, meaning treatments are more easily absorbed. As a result, over-the-counter remedies or treatments may irritate the sensitive skin of the scrotum and worsen eczema symptoms.
Occupation-related scrotal eczema may also occur when a person’s job exposes them to irritating chemicals or products. High temperatures, sweating, excessive sitting, and protective work uniforms all increase the skin’s absorption of irritating substances, increasing the risk of allergic contact dermatitis and irritant contact dermatitis.
There are three main types of eczema that can affect the scrotum: atopic dermatitis, contact dermatitis, and seborrheic dermatitis.
Atopic dermatitis is the most common form of eczema. It develops when a person’s immune system becomes overactive and sets off inflammatory processes that attack the skin — which has a compromised barrier due to lacking certain proteins. Atopic dermatitis most frequently affects the cheeks, arms, legs, and behind the ears. However, the condition can also develop on the scrotum, causing persistent itching and dry or scaly skin.
Atopic dermatitis on the genitals tends to affect the scrotum or the base of the penis. Chronic (long-term) atopic dermatitis on the scrotum causes the skin to peel, ooze, and become discolored. When acute, the condition typically causes the skin to thicken, toughen, and peel.
Contact dermatitis occurs when the bare skin comes into contact with an irritating substance. It typically causes burning and itching where the contact has occurred. Blisters may also form. Two types of contact dermatitis may affect the scrotum: irritant contact dermatitis or allergic contact dermatitis.
Irritant contact dermatitis is common on the genitals. It can result from sensitivity of the skin, as well as sweat, frequent contact between areas of skin, and friction from clothes. Soaps, body washes, moist towelettes or toilet paper, and other products that come into contact with the genitals can also trigger irritant contact dermatitis.
More rarely, the scrotum may have an allergic reaction to a substance, resulting in allergic contact dermatitis. The main symptoms of allergic contact dermatitis are itching and a burning sensation. Personal lubricants and latex condoms have been found to cause allergic contact dermatitis on the scrotum.
Seborrheic dermatitis is a chronic form of eczema that occurs on areas of the skin with high concentrations of oil glands. Seborrheic dermatitis seems to involve hormones, the immune system, and yeast, and other microorganisms that occur naturally on the skin.
Genital seborrheic dermatitis can affect just one area, such as the pubic region or the area around the anus or buttocks. This form of eczema causes the skin of the scrotum to become reddened, swollen, and greasy. Yellowy-white flakes or scales may also develop in the groin area.
There are many possible causes of an itchy, irritated scrotum. They include the following:
If you experience symptoms of eczema on your scrotum or genital area, talk to your health care provider or a dermatologist. Do not try to treat eczema yourself, as certain remedies or treatments may irritate the sensitive skin of the scrotum and worsen your symptoms.
Treating genital eczema often begins with a topical medication, such as a corticosteroid. Corticosteroids (also known as steroids) reduce inflammation, helping to alleviate skin irritation and other symptoms of eczema. Strong steroids are not used on the scrotum because they can thin out the skin.
Topical immunomodulators — such as tacrolimus (sold as Protopic) and pimecrolimus (sold as Elidel) — suppress the immune system in the skin but do not thin out the skin like steroids do. These are good options for the genital area. Crisaborole, sold as Eucrisa, is a newer topical agent that also does not contain steroids and is safe to use near the genitals.
Moisturizers, also called emollients or lotions, can help relieve itching and dryness. It is recommended to wait at least 30 minutes after using a topical steroid cream before applying an emollient to the scrotum and to reapply it after showering or bathing. You can also use moisturizers in place of soaps and body washes, which may aggravate eczema symptoms.
If scratching itchy skin has led to open sores or wounds, your doctor may prescribe antibiotics to prevent or treat bacterial infection. Your doctor may take a culture sample to see if any bacteria are growing on the skin.
Phototherapy — also known as light therapy — is an effective treatment for atopic dermatitis. About 70 percent of people with eczema experience temporary or complete remission with phototherapy. The treatment works by repeatedly exposing affected skin to ultraviolet radiation — from natural sunlight or artificial light — to slow down or suppress inflammatory activity that causes flares.
The genitals are typically covered up during routine phototherapy sessions. However, researchers have found that one type of phototherapy, narrow band UVB therapy, can help improve scrotal eczema, in particular.
Part of managing scrotal eczema involves reducing or eliminating contact with irritants.
Friction and tight clothing can aggravate genital eczema. Wearing loose, comfortable clothing made from cotton can help alleviate irritation. You may also want to try fragrance-free laundry detergents or fabric softeners.
Some men with eczema find that physical contraceptives — such as condoms and diaphragms — cause genital irritation. This is particularly true if you have a sensitivity or allergy to latex. Spermicidal creams or gels, which help prevent pregnancy by killing the sperm, can also cause the genitals to become irritated.
Intense itching is one of the most prominent symptoms of eczema on the scrotum. Some over-the-counter anti-itch products can help relieve this uncomfortable symptom. If these do not help, your doctor may recommend other treatment options, such as antihistamines. They may also perform further testing, as other conditions — such as iron deficiency anemia, or low iron levels — can cause itchiness.
Cutting your fingernails as short as possible may also be helpful if scratching itchy skin has led to injury or irritation.
While keeping the genitals clean is an important part of managing scrotal eczema, overwashing or using irritating soaps can worsen symptoms. It is recommended that people with genital eczema wash the affected areas with warm water and a nondetergent cleanser.
If your shampoo is worsening irritation, apply an emollient to the scrotum before shampooing to protect it. It is also important to wash your hands before urinating or touching your scrotum to prevent the spread of irritating substances to the skin of the genitals.
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How have you dealt with scrotal eczema? Share your experience and tips in the comments below or by posting on MyEczemaTeam.