Red Scrotum Syndrome
Red Scrotum Syndrome (RSS) is an uncommon disease that presents as sharply defined redness of the scrotum. It may involve entire scrotum and extend on the penile shaft. Patients will have a burning sensation, tenderness, and pruritus. It can be confused with a fungal infections, but the absence of scaling should help with the diagnosis. RSS occurs mostly in Caucasian males over 50 years old.
The cause is unknown, but proposed theories include nerve inflammation and an abnormality in function of blood vessels like in rosacea. About half of RSS reports in the literature had a history of corticosteroid use, which can lead to rebound dilation of the blood vessels. Use of steroids in this area should be avoided. A KOH may be done, and your feet may be inspected for a fungal rash.
Treatment
- Stop steroids – you may have withdrawal symptoms that last for 4-14 months and may include burning redness, swelling
- Beta blockers give 2wks
- Topical timolol 0.5% gel twice a day
- Carvedilol 6.75 mg per day
- Dermeleve
- Doxycycline may be helpful – especially if you have a history or family history of rosacea
- Calcineurin inhibitors (Elidel or Protopic- these are often used if you have been on a topical steroid).
- Lyrica 150 mg qhs / gabapentin 300-900mg/day
- Ivermectin – start oral then topical
- Case reports have shown that Eucrisa, compounded triple rosacea cream and doxepin topically can be helpful.
- Compounded triple cream ketamine-amitriptyline-lidocaine
- 50 mg of indomethacin 3 times daily for 10 days then twice a day up to 6 wks
- Ruxolitinib cream