Monday, November 14, 2011

Painful Red Scrotum

Over the past twenty years, we have seen a few patients a year with scrotal burning and/or redness (erythema). Some of these individuals had used topical steroids for prolonged periods, some only for a few weeks. I don't recall if any had not used steroid creams. The condition is called scrotodynia, scrotopyrosis, and red scrotum syndrome. The medical literature gives few clues to its etiology, except that topical steroids can play a significant role in some (or many) of these patients. There is a condition called "vulvodynia" which is similar in some ways. This post tells one patient's story and is a call for information from physicians, other care givers and, importantly, from individuals who suffer with this disorder. It is anonymous. Hopefully as practitioners and patients collaborate we will reach some clarity and start to help those who suffer. If you are a patient making a comment please give your age, occupation and any other information you may consider pertinent.

Patient's History: (November 2011)
I am a health 46-year-old man in the technology field who has suffered with a burning scrotum for past two months. I had knee surgery in May of 2011 which sidelined me from physical activity until September of this year. Upon resuming a workout regiment (primarily of basketball and running) I developed what was diagnosed as a fungal in my groin (tinea cruris - commonly referred to as “jock itch”), specifically in the creases of my thighs. The red scrotum seemed to appear along with the fungal issue, but being unfamiliar with tinea cruris (it was my first time with the condition) I assumed that the red scrotum was part of the same problem. My first attempt at resolving the issue came with a visit to a dermatologist (who I happened to be seeing for a minor skin condition on my hands). It was a “by-the-way can you prescribe something for this rash I have” which first turned our/my attention to the red scrotum.

Initially the dermatologist prescribed Hydrocortisone ointment USP 2.5% for the redness/inflamation and Ketoconazole cream 2% for the fungal issue. The instructions were to first apply the Hydrocortisone to the inflamed area (the creases of my legs were rather red with a fungal rash) for one week to reduce the inflammation. Then apply the Ketoconazole for one week and return for evaluation. I applied the Hydrocortisone to the creases of my thighs and to my inflamed scrotum. The redness in the creases of my thighs subsided marginally but there was no change to the red scrotum. I then applied the Ketoconazole for one week and did see relief of the jock itch. Upon my return to the dermatologist I reported that the fungal treatment was working but there was no change in my scrotum. It was here where I first heard the term “Red Scrotum Syndrome” as a possible diagnosis. I was then prescribed Triamcinalone Acetonide ointment USP 0.1% (a topical steroid) and instructed to apply it to the scrotum for one more week, twice daily, (which I did) and report back. After one week of applying the Triamcinalone ointment to my scrotum there was no change in my condition. I was told by the dermatologist that she was out of ideas and to report to my primary care physician for further treatment.

The visit to my Primary Care Physician began with a careful review of the notes from my dermatologist coupled with a detailed description of what was happening by me. Upon examination my PCP admitted that he had never seen a case like this before. He stated that his medical references offered little help but he did find some info by doing an internet search. The research suggested a treatment of Doxycycline (an antibiotic) 100 mg, twice per day for 10 days. I promptly began taking the oral dose of Doxycycline but after 10 days again there was no change in my condition.

During my initial visit with my PCP I asked if I should stop using the Ketoconazole even though there was still remnants of the tinea cruris. The doctor said to stop all ointment treatment to the groin and instead take an oral anti-fungal medicine to kill the jock itch once and for all. Not knowing the dosage his office requested advice from another dermatologist who upon contacting prescribed Fluconazole (one pill one time). I have taken the Fluconazole and coupled with the Ketoconazole I seem to have the tinea cruris under control.

Next my PCP referred me to a urologist who, like my first Dermatologist and Primary Care Physician, admitted that he had never seen this condition before. He checked my prostate (normal) and gave me a urine test (which also came back normal). The urologist wished me luck and apologized for not being more helpful.

It is here where my luck changed as the second Dermatologist recognized the symptoms and suggested I pay him a visit. Upon examination he too diagnosed the condition as Red Scrotum Syndrome (RSS) or in some circles known as “Great Balls of Fire”. He knew of two doctors (one in Boston and one in Sweden) that have had experience with RSS. Pictures and a description were emailed to each and we await feedback. From prior cases and research the dermatologist advised me to take gabapentin (300 mg 3 times per day). Gabapentin was originally developed for the treatment of epilepsy, and currently is also used to relieve neuropathic pain. I am on day three of the medication and I do not feel any change in the condition.

Hopefully some relief is in sight as the pain is annoying. Some days are significantly worse than others. In fact on some days I continue my normal family and work routine and barely notice the RSS. On other days it’s more pronounced and sitting for any length of time at my desk is uncomfortable. Walking and sitting seem to aggravate the sensation. Having had the shingles (Herpes zoster) at the age of 44 I liken the pain to having scrotal shingles. Perhaps there is something neurological in the equation because I’ve been told that 44 years old is unusually young for shingles. A final note is that high levels of stress (mostly caused by work) occurred during my shingles and when the RSS manifested. A psychological component to the condition cannot be ruled out.

Unfortunately I’ve been told that I am what the medical field calls an “orphan” patient. That RSS exists in a medical space between Dermatology and Neurology and neither discipline is really focused on the condition. I know there are others out there who are suffering with the same pain and that have possibly found a solution to this annoying problem. Hopefully, this post is seen by others, offers helpful information and lets them know that they are not alone. I also hope that any sufferers out there who have had Red Scrotum Syndrome and discovered a remedy reply back and give us a helpful start.

1. Gabapentin for Neuropathic Pain

2.  Wollina U.  Red scrotum syndrome.  J Dermatol Case Rep. 2011 Sep 21;5(3):38-41.  Red Scrotum Free Open Access


  1. Several decades ago I recall listening to an Audio-Digest Dermatology tape where mention was made of treating itchy or burning scrotal syndrome with Castellani's paint. I don't know if this therapy would be appropriate in this patient's case or not; but it might be worth a try.

  2. From a dermatologist in Baltiomre: "I found the description of the red scrotum syndrome interesting – I have seen a number of these frustrating cases over the years so thy can’t be so uncommon. My own opinion is that they are similar in the way to the brachioradial pruritus and notalgia paresthetica i.e. a neuritis or radiculopathy. On occasions, when all else fails to control the symptoms I have referred patients to neurosurgeon for further evaluation in regards to spinal pathology in some have reported back with articular stenos is – perhaps a common finding in a certain age group. I have not had uniform success with any one treatment."

  3. From a patient in Brazil: "My name is Alexander. I live in Brazil and I have 26 years. I am suffering with this redness in the scrotum for 4 months. I've been to 3 urologists and dermatologists 3. None of them know what it is. I've used various ointments and oral medications. None worked. I contacted an American dermatologist via email. I sent some pictures and he assured me that is not the RSS. But I feel redness on the stock, some days more than others. Some days burn and burn. And I have felt a great discomfort in the buttocks, can not sit for long.

    Have you had any response?

  4. I have regarded this rare event as peculiar form of isolated seborrhoic dermatitis confined to the scrotum. Indeed, most of the ointments used are irritation. I would recommend a trial with: (i) eosin 0.5% in water, (ii) a cream containing 2.5% ot 5% of colloidal sulfur, and (iii) as ultima ratio, a trial with an ointment containing a very low amount of capsaicin. After application, this will increase discomfort for 20 to 30 minutes.
    Best regards, FAB

  5. I have been dealing with this problem for about two years. I have tried various topical steroids and also moisturizing lotions like Cetaphil. My latest plan is to take doxycycline twice daily and a custom prescription Gabapentin cream. I am only a few days into this with no change. It's interesting to note that I also had shingles (on my scalp)at about 40 years (I am 48 now). I often wondered if there was a connection. I do sit all day at my job and it has become so painful that I can barely make it through the day most days. If this new treatment does not work. I'm stopping all topical and antibiotecs and will try an anti-depressant. T in PA

    1. I had the same problem for 17 years and I am finally cured. I had an over growth of Candida in my intestines from taking antibiotics for acne and ear aches when I was a child. I also used drugs and drank and eat the wrong things, making my problem worse. I started the Candida diet and after two weeks my problem got better. I started taking anti fungal supplements and my problem got allot better! Almost cured it. The problem is I was still drinking and every time a drank my problem would come back so I went through a vicious cycle. It would get better and worse again. In order to cure it I had to get serious, I went on a 30 Day vegetable juice fast stop drinking and taking drugs. After the fast my problem was 80% percent gone. I went to the doctor and started taking nystatin and diflucan at the same time and on top of that I was taking natural antifungal herbs. (Garlic, Black walnut, oil of oregano, caprylic acid, Pau d Arco, Oregon grape etc. If you need a list just look online under Anti Candida supplements. Also you need to take a probiotic with at least 50 billion.
      It took me 2 years of trial and error but after all this I finally cured myself. If you need help with the process send me a email
      I wish someone would have helped me. So I am making it my mission to help other people.

    2. Your account is by far the most encouraging I've read regarding red scrotal syndrome. I first noticed it in myself 13 years ago and have been suffering off and on since. We share the same lifestyle history in regards to the antibiotics, diet and alcohol use. I will definitely make it a point to follow your regiment. Thanks for sharing your story.


    3. I suffered very badly with Red Scrotum Syndrome. The medical profession was no help. I was told that it must be psychological. So I did my own research and tried all sorts of supposed remedies. After a year of hell and no sex I cured myself. I have written a short E-Book about my experiences. It is available at and I'm only asking $1.99 to cover production and hosting costs. When my advice cures you though, I'd appreciate it if you go back and make a donation of what you think the advice was worth.

  6. I have seen just a few patients like that. They all had contact dermatitis one to corticosteroid, another to quinolonmix and yet another one to a preservative in a barrier cream. Wool alcohols are quite common allergens too in this context. I think that contact allergy should be ruled out before the diagnosis genital skin burning syndrome is made. J. Wallengren, Karolinska, Sweden

  7. Dear colleagues
    I prefer a trial of topical pimecrolimus and bland petrolatum jelly. It seems to help, though temporarily. Ask my patients to use the wet towel technique.
    Dr Manish Pahwa
    Max Hospitals
    New Delhi,India

  8. Hi,
    I am 40 year old male from Norway who has suffered from this condition for a year now. My story started exactly like the patient story told by dr. Elpern. I have tried “everything”, visited many doctors, and done a lot of internet-research (I am a researcher myself, unfortunately not in medicine). In 2010, “Red Scrotum Syndrome” by Uwe Wollina was published, and recently “Dysaesthetic penoscrotodynia: nomenclature, classification, diagnosis and treatment” was launch. These two articles sum up the story so far. So far, no one has come up with a good solution.

    Also the HealthBoard: is a source to good and interesting patient stories. I have not found many (any) stories from Norway or Europa (which is strange…).

    When it comes to my own case, I know that the condition was triggered by the use of Canesten. I was perfectly fine until I was so stupid to use it on my scrotum. There is something in that stuff, and other similar products, that cause this problem for many. Similar stories are told by many.

    Based on what I have read, and my own case, I believe that the problem is related to the nerve system. It more or less seems that microscopic nerve signals has “gone crazy”, something which causes hyper sensibility and the sense of hot and cold feelings, which again leads to skin contractions and expansions, sweat, cold-sweat and soreness/burning/itching.

    In the beginning, I tried everything in, one thing at the time, and I discovered that everything I put on in the end made the condition worse. Nothing I tried orally (doxycycline and so on) helped. The fact that everything I smear on make it worse, I believe is strengthening my nerve-theory. Everything that seals the skin makes it probably more difficult for the nerves to operate as normal. I must admit that stuff that contains alcohol, or for instance mint and similar stuff gives a short relief, but that is probably because it numbs the nerves.

    One month ago, I stopped putting on anything. And I will continue this abstention as long as I can. I use Lyrica to take away the worst pain, and recently I have bought a TENS-machine which also helps me a lot. I cross my fingers and hope that I will become better. Thanks for trying to find a treatment!

    Depressed Norwegian

  9. I had the same problem for 17 years and I am finally cured. I had an over growth of Candida in my intestines from taking antibiotics for acne and ear aches when I was a child. I also used drugs and drank and eat the wrong things, making my problem worse. I started the Candida diet and after two weeks my problem got better. I started taking anti fungal supplements and my problem got allot better! Almost cured it. The problem is I was still drinking and every time a drank my problem would come back so I went through a vicious cycle. It would get better and worse again. In order to cure it I had to get serious, I went on a 30 Day vegetable juice fast stop drinking and taking drugs. After the fast my problem was 80% percent gone. I went to the doctor and started taking nystatin and diflucan at the same time and on top of that I was taking natural antifungal herbs. (Garlic, Black walnut, oil of oregano, caprylic acid, Pau d Arco, Oregon grape etc. If you need a list just look online under Anti Candida supplements. Also you need to take a probiotic with at least 50 billion.
    It took me 2 years of trial and error but after all this I finally cured myself. If you need help with the process send me a email
    I wish someone would have helped me. So I am making it my mission to help other people.

  10. Post sent by S. Payne:
    I have been suffering with RSS for almost a year now. There is nothing remarkable about how it arose, it just sort of came about. I am 32, in remarkable health. I lift weights five days a week and run. In February of 2011 I ran a 10k. A couple of weeks later I started having what I thought was a bout of jock itch. I didn't pay attention to the color of my scrotum, but it itched a great deal and I would scratch until it was raw. I decided to go and get some lamisil. I treated with that for a couple of weeks and then, as directed by the box in which it came, scheduled a doctor's appointment because the condition hadn't gone away, it had just worsened... This comment is too long for Blogger -- so it was converted to a Google DOC -- see

  11. AnonymousJuly 01, 2012

    I have been experiencing what seems to be a yeast or fungal infection of the groin which has resulted in red and itchy scrotom. I tried various topical treatments for some weeks including,teatree, Canesten and Lamisil, on what started as a localized patch with an itchy boarder in my butt crack. However after some exercise it spread to my scrotum and inner thighs. The skin began to weep and was extremely sensitive, at that point I went to a clinic and was prescribed a steroid ointment antifungal cream and oral anti fungal drug kenoconazole (200mg twice daily) This regime had immediate results and the swelling and weeping resolved. However 10 days into the treatment the scrotal skin remains red sensitive and itchy. One of the things I have noticed is that heat and sweet foods make it more intense. As yet the problem has not resolved and the improvement has leveled off. The infection seems to be deep in the skin and quite persistent. The skin of my testicles is very sensitive to salt water and sweat and as such it must be corrupted as it is more permeable that normal skin. I shower and fan dry the area 3 times a day to prevent sweat irritation as I live in the tropics. The itching sensation also can manifest as a tickle and as local point burning/biting sensations and or a general buning sensation. I made up an alcohol based menthol spray which provides temporary control of the sensations, however it is rather intense on application. Hope some of this is helpful

  12. AnonymousJuly 04, 2012

    I have had a red scrotum for 20 years or so. Borders well defined, like a map. Very red on one side of border, than totally normal on other side. Now after a sexual encounter 6 weeks ago, (burning started 3 days later) my scrotum burns constantly. Worse when sitting and now involves anal area like diaper rash. Dermatologist did culture which showed yeast and staph. Took doxycline and Cipro for 10 days. Also used every anti bacterial creme possible. No better. Dermatologist did 2 biopsies which came back "intertrigo". Hard to believe diagnosis as this is a skin to skin abrasive problem. Why did burning start 3 days after sex event? Derm. recom. Biafine ointment which helps for about 20 minutes. Very depressed.

  13. AnonymousJuly 07, 2012

    hello from canada

    male, at age 77 diagnosed with Grovers disease, or :transient acantholytic pueritic dermititis. supposed to last about 1-2 years. Treated with much topical steroids. about 18 months into treatment, the RED SCROTUM SYNDRONE began. The grovers is gone but the rss is present and is ruining my life. Painful to sit,ride bikes etc. Scrotum red and painful under slight pressure, no scaling, or lesions no cracking, just localized redness mainly at the sides with normal colour at adjacent legs.

    dermotoligist have few clues said it was eczema, have been prescribed steroid creames, made it worse. Tacrolimas which is an immune supressant, no effect and dangerous. Last prescribed was a rosacea cream, no effect. Have tried fungal powders,calomines none work, and gold bond cream, which has a local pain killer , but also has a steroid, it helps with the soreness,but only temporarily.Hve not tried any internal meds.

    I am now trying the coconut oil and mild cleansing solution(from one post) which worked for awhile but now does not.From the many posts and sites i visit this problem is addressed by people ranging from legitimate medical and scientific groups and patients to hypocondriacs and con artists pushing products.

    We must find out what causes it , because the symptoms are exactly the same, very red, very sore under pressure and localized to scrotum. We know what it is not, from the many potions we have tried. If there is anbody that has actually cured this condition lets hear from you. i am 5-11 185 pounds, have been very active in riding sports, and now sore as H--- and angry that we can land on the moon but not cure RSS


  14. Hi Guys, I had this in 2007 and got rid of it. I have had several small tangles with it since but have avoided the big break out. Now I sit here in 2012 with it again, and FAR worse than before... I know how you all feel, it sucks, however there is hope. Here is what I have learned.

    How many of you thought this was jock itch or something along those lines and you started using anti-fungals and hydro-cortesone when this all began?

    I have tried antibiotics, anti fungals, tea tree oil, lavendar, rosemary oils, coconut oil, lemongrass, iodine, peroxide, all kinds of prescriptions, you name it! How many posts do you see with "try this or that" STOP IT!

    This condition is called Lichens Simplex Chronicus. Its a form of neuro-detmatitis caused by cycles of irritation (scratching and chemical irritation) it itches, you scratch it or blast it with god knows what. That leads to a stronger itch so you scratch it more or put more "cure" on it and it goes on and on and on. It becomes habitual, you are scratching your junk and you dont even realize it. You do it in your sleep.

    When youre desperate you try anything, I know. I once poured pure tea tree oil over my sack, talk about pain!

    You have a serious problem now, your scrotum is sensitive to anything and everything. Its some of the most delicate skin on your body. Because you are where you are now, whats OK for most other guys IS NOT OK FOR YOU anymore so you have to think differently and smartly.

    Remember the goofy kid in elementary school that got picked on because he couldnt go outside,couldnt eat normal food, had to take medication,and was sick all the time... thats now your scrotum.

    If you have a fungal issue, it will be in your groin, not on your sack or penis. you may get a little of it on the back side where your sack meets your body but thats it. DO NOT PUT ANTI-FUNGALS ON YOUR SACK. Over the counter antifungals should NOT BE USED EVER... you have a severe sensitivity now and those things are harsh, lotrimin ultra is the WORST. If you suspect jock itch go to a doctor and have a scraping done and they can tell if there is yeast there or not. If you do need one, use it sparingly and apply 1 or 2 times a day, slathering more and more on doesnt make the fungus go away any faster. Follow youru doctors directions, and ask if he doesnt explain how to use it to you.

    Often we try anti-fungals then when they dont work, we immediately assume it has to be bacterial and start applying things like crazy. Also as a point of interest, do you know what the #1 skin allergy is caused from? one of the components of neosporin and triple antibiotic. look it up.

    Yeast and bacteria live on your skin and keep each other in balance. If you go crazy with antifungals, you are inviting a bacteria over growth condition, want interigo on your junk? keep applying antifungals.

    Over treat with anti-bacterials, youre asking for a yeast or fungus issue. Yes, this includes antibacterial soaps, stop using them in the shower.

  15. part 2
    Did you get the last 2 paragraphs? understand that if nothing else, youre causing your own problem.

    SO on we go, not we start getting red, inflamed, burning so we reach for the hydro-cortisone creme, guess what, now youre allergic to it or damn near. its a NO-NO now and it wont work anymore.

    Get rid of any non hypoallergenic soaps, lotion, laundry detergent, etc. Your time for using that stuff is over. Stop scratching and moisturize like a fiend. Cerave, eucerine, cetaphil are all of your choices now. Stop using regular soap, basic dove is the only option.

    LEAVE YOUR SACK ALONE, stop scratching it, touching it, rubbing it, etc. Its a battle of the mind now my friends... Cut your nails, file them, pat the area if you have to touch it. I know the best thing about this condition is how good it feels when you scratch it, sometimes you think you will have an orgasm while scratching.

    Stop taking hot showers, and soak in a warm salt bath (mineral salts not table salt) once a week.

    When it itches, put cold compresses on it, frozen bags of vegetables work well but dont over expose to cold. If you use something frozen, put a dish towel between you and the frozen item. You will see that your color almost goes back to normal, and as it heats up the red comes back. Thats not infection or fungus, its irritation and over stimulated nerves.

    Moderation is key, no extremes of temperature, chemical applications, etc...

    If you can find a good derm or if your GP is useful, get s script for desoximetasone .25% and mix it 50% with aquaphor (available at most drug stores) apply 2x a day. also get a strong antihistimine - one that will make you sleep and keep you from scratching in your sleep like hydroxizine. Use the desox for 10 days no more...

    Keep moisturizing with cerave (my recomendation) and if you have to go out and cant do it every few hours, use aquaphor right out of the jar. its sort of like vaseline and will stay put for a long time and do its job. Also good before bed!

    This can take 2,4,6,8,12,16 weeks to resolve, but stay the course. I have found vitamine A, E, C, zinc, and sea kelp to be helpful in support.

    Once you are back to normal be extremely paranoid about putting anything but water on your sack keep it covered with nice cotton. You have a delicate issue with your scrotal skin and it wont ever go away so be extremely careful with what you do and what you apply down there.


  16. RSS has a different name and it does have a solution: Scrotal Neurodermatitis.

    1. Started with red skin and red small dots on my inner thighs
    2. It looked like a regular infection from sweat.
    3. I’m a runner and usually get this on my chest and rarely on my crotch.
    4. I used Canesten which has always helped.
    5. The red skin on my thighs got better during the first 2 days.
    6. On the 3rd day my scrotum got very red and itchy
    7. I put canesten on my scrotum and showered with antibacterial soap (BIG mistake)
    8. I suspended canesten and antibacterial soap after 1 week.
    9. I started missing sleep, I would wake up at 2am with my scrotum in flames.
    10. I started reading blogs online, the online pictures looked exactly the same, the symptoms were just like what I had.
    11. During the day it would be ok, but at night it was just awful.
    12. I remembered a special soap that a urologist suggested to treat/avoid human papilomavirus from developing (I have it and my girlfriend developed it) in men if we have a good higiene we should be ok.
    13. I started using this soap, this is in Spanish since I’m in South America: “Saforelle Fem – Bardana Dinafitoles” is the commercial name.
    14. This soap is sold in pharmacies over the counter, it’s liquid and makes foam like a regular soap.
    15. The soap helped a lot, I showered my scrotum and legs twice a day with this and it just alleviated the itch and redness for about a week
    16. One day I thought I was completely cured so I thought I had found the cure, however I was wrong, that night was one of the worse.
    17. The itch was different, it was like electric shocks on my scrotum, I didn’t scratch even once cause I knew that would just make it worse… but I could feel the electricity… like this tingling feeling. If I could draw it, it would be like an electric feel/lightning on my balls.
    18. That day I got no sleep, I took a shower at 3am with the soap I described before and that helped somehow.
    19. I spent hours that day online, reading. I was ready to go buy antibiotics and get a doctor’s appointment that morning… but I had never looked up this issue in Spanish (usually there’s more info on anything in English than in Spanish) but I gave it a try.
    20. There’s less info in Spanish, however there’s a different perspective of this issue. They relate the RSS to Scrotal Neurodermatitis.
    21. Dermatologists who find these symptoms send their patients to psychologists/psychiatrists.
    22. It immediately made sense in my head. This is not a skin infection, or anything you can treat with antibiotics… this is all in your head.
    23. I had a very rough break up with my exgirlfriend that really messed up my head, I became very anxious.
    24. I would say I had been experiencing something I would call sexual anxiety, like thinking too much about sex, and I knew it was all related to this past experience with my ex that was not solved.
    25. So since that day, I have kept on showering with the soap above, and meditating, letting things out of my head, facing my past, looking at women with respect, letting the anxiety out… and this has been the answer for me. Sometimes I feel the tingling on my scrotum and I just relax and observe my mind and it calms down.

    So in a few words:

    1. I got a regular skin infection from sweating.
    2. I used Canesten and antibacterial soap, I got an awful rash on my scrotum which weakened my scrotum skin and created the right environment for Scrotal Neurodermatitis.
    3. I stopped the scratching and started using “Saforelle Fem” soap helped cure the skin and infection, which alleviated the itching.
    4. I would say RSS is actually Scrotal Neurodermatitis which means it will cure when the issues in your head are solved.
    5. Look inside your mind and you will find the answer.

    I have not seen a doctor or psychologist but I do believe in the power of the mind… it’s very powerful to do amazing and beautiful things, but it can also work against you. Read more about Scrotal Neurodermatitis, the answer is there.

    I really hope this helps you all out there. Good luck, you are not alone.

  17. I wrote my paste contribution in December, and I am now happy to say that I have had a long period (since the spring) with no problems at all! In short I agree with what Rick McCall writes. The problem we are experiencing is probably some kind of nerve hypersensitivity caused by stuff that has been deliberately or not deliberately applied / come in contact with scrotum. And since people do not know much about this, all the tries of different balms and so on, makes the condition much worse.
    So the cure is to not put on anything, and of course; this is very difficult since this condition drives you crazy. But I have found a way to deal with the pain so that the scrotum can heal. The solution is to use a TENS-device, see:
    When my scrotum hurts, I put the pads on at the inner side of my thighs and use as high power as I can. In the beginning I use this the whole day through, everywhere; at work, when travelling etc. I bought a small device, and then it is possible to use without anyone noticing. After some time, the use can be reduced to when you feel it is necessary.
    So what will happen? When using the TENS-machine, the pain from the machine will overshadow the pain from your scrotum, and the pain caused by the machine is a “nicer pain” which is possible to live and function with. For instance, I have no problem concentrating and work when I use the TENS-machine.
    Will it cure the problem? To me it has, but I do not know exactly how. The supporters of the TENS-machine claims that it does several things. First of all it releases endorphins which are the body’s natural pain killer, and this makes it possible to cope with the scrotum pain. Secondly, they claim that the pain signals from the TENS-machine get the priority in your spine; the pain signals from your scrotum are given a lower priority. A theory related to chronic nerve pain is that gate between the problem area (to us; scrotum) and your brain becomes “too open”. And also when the problem area actually gets better, the brain starts to search for/demand the pain signals and by that actually is creating pain signals (creating oversensitivity). It could be that this is correct, and that the TENS-machine is stopping this vicious circle. I do not known, but the use of this machine has cured me.

  18. Hello from Canada #2

    from my above post, i have had 2 derms treat my RSS . I recently tried a prescription for rosacea which failed (it should have been obvious this RSS was not rosacea)

    In the last 2 months i was prescribed a tetracycline cream for 3 weeks which failed to have any affect, other than to make it worse.

    then from the same derm and at my insistance we tried a course of internal tetracycline anti. bio , the same product as doxycline which was purported to have worked by a sufferer. These 2 antibiotics had no effect except in the case of the capsules which produces intestinal gas. I tried both of these for 3 weeks and saw not result.

    My scrotum is now as it has been for nearly 2 years, red and very sore under slight pressure from clothing. I NEVER SCRATCH it. It is actually not very itchy.

    This condition of RSS is not a fungus, not rosacea, not caused by physical abrasion,not apparently some immune response ie (tacrolimus had no effect) it is shown recently not to be biological in nature. Many of the so called cures appear to be the usual scams associated with skin problems.

    I am back using the oil emolient i previously mentioned as it adds a bit of comfort, and when i travel and run machines, i apply some gold bond ointment wich has a contact anesthetic,but also has a bit of steroid. I dont do this very often, but it makes activity bearable. I realize the suggested connection to steroid use.

    As i stated in the former post, i has prolonged "grovers disease" which is now gone after about 4 years, in that time i used a lot of topical steroid, which was never applied to the scrotum, and i no longer use it. I do however use about one benedryl per night, which i took for the grovers.I am going to consider a possible allergy to benedryl?

    It appears that those who believe RSS is a neuralogical condition may be correct, and i am going the use the little or nothing route. I see this Derm soon and i will accept no more potions.

    I do feel the condition is slowly receding? as the white skin at the edges ( inner leg) seems to be moving into the redness-------I hope.

    ps--i dont have time to check spelling- sorry

  19. I had this for about a year - I had very, very good results with virgin coconut oil as a lotion down there. I applied once in the evening and once in the morning. It is my understanding this oil has anti-fungal properties, as well as a mild acid as well.

  20. AnonymousJuly 17, 2013

    did anyone here had a patch test done for allergic contact dermatitis?

    I think that it could be the source of the problem for many who suffer from RSS.

    consider the following (very likely) scenario:

    1) you got some simple problem like tinea cruris and treat it with cortico-steroid (cortisone) creams.

    2) the cortico-steroid creams damage the skin
    barrier (top layer of the skin) and now the inner layers of the skin are in direct contact with your body wash or laundry detergent.

    3) your immune system fights the allergens, but "remembers" that the most severe point of contact was the scrotum area.

    4) every time you come in touch with the allergen, even if it's by washing your hands with a soap that contains it, your immune system triggers an anamnestic response, which shoots histamine to your scrotum, resulting in a horrible burning sensation which can take 2 - 4 weeks to go away according to an article about Allergic Contact Dermatitis on the Mayo Clinic's website.

    so the question is:
    did you get an allergy contact dermatitis patch test done? if yes, what are the results, and if not, why not?

    if you are allergic to common preservatives which are pretty much everywhere, you might be triggering this over and over without knowing what causes it.

  21. AnonymousJuly 29, 2013

    Several years ago I had shingles on my anal region. Very painful I might add. Just recently I too developed RSS. It was driving me crazy, scratching to the point of bleeding. The doctor put me on a steroid cream which helped very little and seemed at times to even make the irritation worse. My wife and I decided to cut sugar, white flour and processed foods out of our diet after reading a book called The Great Cholesterol Myth - this decision was unrelated to my RSS condition. One thing the book said was that sugar was a major cause (or rather it fed) inflammation in the body. Low and behold my RSS condition began to subside, I believe as a result to cutting out the sugar, white flour and processed foods. My wife does body hair removal using Natural Sugaring Method, she suggested that she sugar that area of my body to further reduce the irritation caused by hair rubbing as I walk (I'm a letter carrier so I do a lot of walking everyday) ... that helped too - and contrary to what you might think it wasn't painful, just mildly uncomfortable the first time after that it was no problem. I also found that using over the counter Benadryl (an anti-itch cream) stopped any further desire to scratch. I put it on at night when I go to bed, and first thing in the morning when I wake up. I carry a tube with me during the day and apply it as needed. The RSS condition has almost completely cleared up in just 3 months, what a relief!! I am still vigilant with cutting out sugar and such, and still have my wife do hair removal treatments on a regular basis ... but for all intents and purposes I believe I have beaten the RSS.

    I hope this helps anyone suffering from the same condition ... it is a living hell ... but it doesn't have to be.

  22. Nothing known to medical people cures this yet but menthol in creams helps the itch and burn and zinc oxide helps a lot.

    No cures just helps and makes it bearable. I have been through all the medical garbage and you will get Canesten, protopic or corticosteroid cream. Protopic made it fare so bad I thought I woul have to cut my balls off. Canesten did very little. Menthol helped sooth. Using less covers at night helped some.

  23. I find applying salt in the shower and leaving it for a few minutes before rinsing it off helps alleviate the symptoms. Interesting to read that I have a lot in common with those above on the use of caneston and anti-bacterial soaps contributing to the problem - will stop using these to see if this totally eliminates the problem and report back . . . . Kiwi

  24. AnonymousJuly 08, 2015

    I have suffered from red scrotum syndrome for six years. It was caused by application of cortico-steroid creams that were prescribed by a really stupid doctor who insisted that he knows what he was doing and that I should trust him.

    I actually posted in this thread in 2013, so this is sort of an update:

    I finally got treatment that helped! and the last couple of months were the first in years where I could function normally.

    The treatment was done with Medical Needling, by Dr. Matthias Aust of Germany. He is the expert on Percutanous Collagen Induction, and has published his research in the book:

    If anyone suffers from this horrible horrible condition -- I strongly recommend contacting Dr. Aust for consultation --

  25. AnonymousJuly 21, 2015

    I've suffered from this for 6 years, and have finally found a cure. The solution is Medical Needling, which rejuvenates the skin that was damaged due to the cortico-steroid creams. It is the only way that I could find to reverse skin atrophy. I actually flew to Germany to be treated by Dr. Aust, who is a pioneer in the field.

  26. Greetings from the US. I have had this problem off and on throughout my adult life however a bout which began 4 months ago has yet to recede and it's getting very very mentally distressing.

    It began as with so many of you with a fungal infection. I applied the creams to my thighs and scrotum and while the fungal infection went away, the scrotum problem got worse.

    Fungal creams tried: Clobetazole, Nystatin, Ketoconazole

    Steroid creams tried: Hydrocortizone, triamcinalone, desoximethasone

    Non-steroid creams: Elidel

    Steroid injection: triamcinalone (no improvement)

    Oral medication: doxycycline going on two months now (no improvement), gabapentin (some improvement, but mental side effects)

    Other Topicals: Coconut oil, plain petroleum jelly, olive oil, Vanicream, tea tree oil, lavender oil, vitamin E oil, straight rubbing alcohol

    Supplements: Garlic, lysine, fish oil, evening primrose oil, oregano oil, cod liver oil

    Allergen removal: washing underwear only in vinegar and hot water, towels in non-detergent hypoallergenic laundry soap, only using Dove Sensitive Skin in shower, abstaining from all other shampoos or conditioners in shower

    Diet change: Candida diet for two weeks

    Basically nothing has worked. I've put nothing on the area for weeks now and I still have a red burning scrotum where the only skin affected is the "stretchy skin." It burns with any kind of pressure from clothing. I'm fortunate to be able to sleep well at night...for some reason it doesn't hurt when I lay down. Sitting makes it worse. Standing is somewhat better.

    At this point I have been diagnosed with groin dysethesia. Here's a great article describing exactly what we have all been experiencing:

    For me specifically, moisturizing only seems to make it worse. I have found some relief by not washing the area at all in the shower, drying thoroughly using the cool setting on a hair dryer, and applying benonite clay powder to the area. For whatever reason, in my case, keeping the area bone-dry seems to be more effective than moisturizing.

    The best conclusion I can come up with is that the nerves there have developed into "always on" sending pain signals. That must be why the gabapentin helps, because it's directly changing how my body interprets the nerve signals.

    I am awaiting consults with another dermatologist (second opinion), urologist (to rule out other diseases), and neurologist. I'm pinning most of my hopes on the neurologist and urologist working together. I am hoping they can consider something like what is listed here:

    In that article, that authors describe using nerve blocks and ultimately cutting nerves to the affected area if there are no other possible solutions. I am hopeful that my new team of physicians will be willing to try the nerve block procedure to see if I am a candidate for the surgery.

    I am also going back on the candida diet and ceasing the doxycycline because it would have started working by now if it were going to. Candida is likely not the cause of the problem, but it could be contributing to the pain, and there is certainly nothing wrong with eating clean for 30 days.

  27. I am a 61 year old male who is retired and had worked in the technology sector. I have had the red skin on my scrotum for maybe 15 years. Fortunately I do not have really any other symptoms although I may have a slight itch but nothing that bothers me much. I do have a very bad back and have had surgery and a spinal fusion. I take gabapentine for nueropathic pain and also opioids for chronic pain. I actually never even noticed it until on a doctor visit I was asked about it. I have had jock itch in the past but do not have a problem with it now or for maybe the last 30 years. After reading about this I guess I feel lucky that I have no other symptoms. The redness is only on my scrotum and it may feel a little warmer than surrounding skin. I have fair complexion so it is more noticeable I think. I have not tried anything to treat the condition. I really do not know how long I have had the condition because without symptoms I guess I thought everything was normal until the doctor asked me about the redness.

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  29. I followed the advice given on one RSS forum and it has helped tremendously: 1) I never use soap on my groin, only cetaphil gentle skin cleanser. 2) I apply palmer's unscented cocoa butter after my shower in the morning to my scrotum. 3) I switched to smooth underwear. I don't know if the underwear makes any difference or not. When I first started the cocoa butter, I applied it four times per day. I was eventually able to get it down to once per day after my shower. I hope this helps somebody. When mine gets bad it burns not only my scrotum, but also my butt and even my feet and shins. I hope that there is a cure someday for us! The cocoa butter and cetaphil gentle skin cleanser have helped me a lot.

  30. Hello everyone, I am 30 years old healthy no other issues. I first encountered this problem 8 years ago. Just as you all did I tried EVERYTHING to no avail. I believe this problem is caused by chronic anxiety / stress now chronic stress messes with your central nervous system and can give you a whole list of weird and wonderful issues. I think the toughest pill to swollow is that there is NO quick fix or magic medication. My problem came back again after another massive bout of anxiety its the only link that makes sense. So bland Moisturising creams NO MEDICATED creams and lots and lots of stress management meditation and self love once this is all reduced your system will go back to normal and reset any imbalances which were brought on by stress and anxiety. Can anyone else make the link?


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