Red scrotum syndrome: idiopathic neurovascular phenomenon or steroid addiction?
Tarun Narang A , Muthu Sendhil Kumaran A , Sunil Dogra A D , Uma Nahar Saikia B and Bhushan Kumar CA Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
B Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
C Consultant Dermatologist, Silver Oaks Hospital, SAS Nagar, Punjab 160055, India.
D Corresponding author. Email: sundogra@hotmail.com
Sexual Health 10(5) 452-455 https://doi.org/10.1071/SH13052
Submitted: 11 April 2013 Accepted: 25 June 2013 Published: 13 September 2013
Abstract
Background: Red scrotum syndrome (RSS) is not infrequent but is often misdiagnosed or underdiagnosed, and seldom reported. The exact etiopathogeneis is still unknown but it almost always follows the prolonged application of topical corticosteroids and is characterised by persistent erythema of the scrotum, associated with severe itching, hyperalgesia and a burning sensation. Objective: To evaluate the clinicoepidemiological profile and assess the efficacy of various treatment modalities in addition to corticosteroid abstinence in the treatment of RSS. Methods: Twelve patients with RSS, who presented to us during 2010 and 2011, were identified, and various aspects of their illness and treatment were studied. Patch testing was performed in all patients. A skin biopsy was done in seven patients. Results: The average age of the patients was 45.83 years (26–62 years). The average duration of illness or the duration of topical steroid use was 27.41 months (6–56 months). Psychiatric comorbidities were seen in 9 (75%) out of 12 patients. Histopathology revealed features resembling erythematotelengiectatic rosacea in four of the biopsied patients. Patch test results were negative. All patients reported improvement of their symptoms within 4 weeks of starting doxycycline with amitriptyline or pregabalin; the treatment had to be continued for 3–4 months. Conclusions: RSS appears to be a manifestation of corticosteroid misuse rather than a primary disease. We suggest that RSS is a rosacea-like dermatosis or steroid-induced rebound vasodilation based on clinical and histopathological features. Our patients responded to cessation of steroids and doxycycline in combination with amitryptaline or pregabalin.
Additional keywords: pregabalin, rebound vasodilation, rosacea-like dermatosis, tetracyclines, topical corticosteroids.
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