What Is Scrotal Eczema? | Symptoms | Causes | Other Possible Causes | Treatment | Get Support

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).

What Is Scrotal Eczema?

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.

Symptoms of Scrotal Eczema

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.

Classifications of Scrotal Eczema

Researchers have classified scrotal eczema into four different types based on severity and symptoms.

• Type 1 — Called mild acute dry type scrotal eczema, this type causes distinct patches of discolored, irritated skin and intense itching and burning. The symptoms of type 1 scrotal eczema may last for several days or weeks and clear up on their own.
• Type 2 — In severe chronic dry scrotal eczema, the scrotum becomes scaly and takes on a discolored appearance.These symptoms, along with burning and itching, may also affect the groin area and the penis.
• Type 3 — Chronic wet scrotal eczema affects the entire scrotum, as well as the insides of the thighs. It is characterized by weeping (oozing) that causes the affected skin to start breaking down (maceration) and may lead to painful sores and an unpleasant odor.
• Type 4 — Called ulcerated and edematous scrotal eczema, this type occurs when the skin of the scrotum has become swollen and started to deteriorate (ulcerate). The affected area oozes fluid and pus and is very painful. Severe cases of type 4 scrotal eczema can result in tissue death (gangrene) that migrates from the scrotum to the lower abdomen and legs.

Scrotal Eczema and Male Infertility

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.

What Causes Scrotal Eczema?

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

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.

Irritants

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.

Types of Eczema That Can Affect the Scrotum

There are three main types of eczema that can affect the scrotum: atopic dermatitis, contact dermatitis, and seborrheic dermatitis.

Atopic 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

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

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.

Other Possible Causes of Skin Symptoms on the Scrotum

There are many possible causes of an itchy, irritated scrotum. They include the following:

• Sexually transmitted infections — While many are asymptomatic, STIs such as genital herpes and syphilis can cause sores to develop around the genitals that may resemble eczema lesions.
• Fungal Infections — Fungal and yeast infections frequently affect the genitals. This is because intertriginous areas — areas where skin folds on itself — provide moist, warm environments in which fungus and yeast like to grow.
• Psoriasis — Psoriasis, like eczema, is a chronic autoimmune disease that affects the skin. While psoriasis is less likely to affect the genitals than eczema, it is possible for dry, scaly psoriatic lesions to develop on the scrotum.
• Lichen planus — Lichen planus is an inflammatory skin condition that affects the skin and mucous membranes, causing swollen, irritated patches of flat, itchy, discolored bumps. An estimated 20 percent of people with lichen planus develop the condition solely on their genitals.
• Extramammary Paget disease — This is a rare form of adenocarcinoma (cancer affecting the glands’ mucus-producing cells). It most commonly affects the scrotum, causing symptoms that may resemble scrotal dermatitis, such as pain, burning, and itching that may lead to lichenification when scratched persistently.

Because these other conditions can complicate diagnosis, a doctor will typically perform a patch test when allergic contact dermatitis eczema is suspected as the cause of your symptoms.

Treating Scrotal Eczema

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.

Topical Medications

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

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.

Antibiotics

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

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.

Avoiding Triggers

Part of managing scrotal eczema involves reducing or eliminating contact with irritants.

Clothing

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.

Physical Contraceptives

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.

Managing Itch

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.

Practicing Good Hygiene

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.