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It is impossible to make a diagnosis over the internet, but the history that you describe is consistent with red scrotum syndrome. The other common cause of red skin on the scrotum that you did not mention is a fungus that is different than yeast, referred to as tinea or dermatophyte. This is usually treated with a topical anti-fungal. It is a condition, though, that would usually be readily identified by a Dermatologist, so it is doubtful that this is the problem. The diagnosis of red scrotum syndrome usually is based upon clinical examination and a biopsy is usually not helpful, except it may be necessary to exclude other conditions that may be present based on the findings on examination. At this point, it would be reasonable to try empiric treatment with doxycycline, which is usually the better tolerated of the two drugs and has more reports regarding success compared to the gabapentin.
Hello and thank you for your help,
Would tinea or dermatophyte show up in a biopsy? I forgot to mention I used an ani-fungal cream in conjuction with the cortison for about a week (but not sure if i should have used it longer).
As far as use with Doxycycline, I use to take the drug as a teenager for acne problems. Do you know what the success rate with the drug is? If this does not work, are there any other means of treatment available?
If this is Red Scrotum Syndrome, does the condition subside or this something that is ever present and extremely painful to live with?
Would you know of a particular clinic that specializes in this type of condition so I could confirm if this is what I have?
Lastly, could I get your advice on how I should proceed foward and what you recommend I do as a next step.
Thank you again and appreciate any help.
If there is concern about tinea, then the usual study for evaluation would be a scraping of the area that is then looked at under the microscope after a specific solution (potassium hydroxide) has been added to the slide. The conditions for which a biopsy may be helpful would be to rule out certain forms of dermatitis. The anti-fungal cream was intended for treatment of tinea, and there should have been some improvement in a week, although it may not have resolved completely in that time.
Typically, red scrotum syndrome is considered a chronic condition. Since red scrotum syndrome is such a rare condition, it is difficult to perform studies on a sufficient number of patients to truly define the success rate for any medicines. The information on possible treatments is based upon case reports or small cohorts of patients. As noted above, there are more reports of the use of doxycycline, but there are also reports of the successful use of gabapentin. Since this condition is rare, your best option would be to ask to be referred to the regional teaching hospital where an examination can be performed and consider empiric treatment with doxycycline.