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Coachrobmd, Internal Medicine MD
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Excessive Scrotum Itching - No Rash

Resolved Question:

Hi! For the past week, give or take a few days, my scrotum has become excessively itchy. It has recently become so bad that it woke me up several times last night from being so severe. My first indication was the possibility of Jock Itch which I have never experienced. I purchased some Lotrimin Ultra (Butenafine hydrochloride 1%/antifungal) this afternoon and applied it after showering which brought some temporary relief, but even as I write this the itching is back.

I did some research on Jock Itch and noticed it usually is accompanied by a noticeable rash in the groin area, but there aren't any signs of this on me. I did notice a day or so ago that the skin on my scrotum is peeling but doesn't seem to be the case now. The only other area where I occasionally get this itching (and not so much the last two days) would be the small area of my penis right on the circumcision line on the underside. Both this area and the part of my scrotum that are being problematic are somewhat "leathery" (for lack of a better term?) but have no signs of any rash that I can tell. The only discolored area is the underside of my penis which is slightly darker toned, but has been that way for as long as I can remember and don't believe it's relevant to this situation.

All of that said, I'm looking for an opinion on what this could possibly be and what OTC treatments are recommended. Is it possible that it's jock itch but without the rash? If it's not jock itch, would using Lotrimin worsen the problem? I've never had an occurrence of this magnitude so it's unfamiliar territory for me. I do not currently have medical insurance and would prefer to skip the dermatologist and prescription medications as they are rather pricey, but if alarming enough I would eat the out of pocket cost.

General info: 27 years old, generally healthy, 5'8", 150lbs, vegetarian, smoke (but cutting back and quitting). The final thing that worries me is that my sex life has included multiple partners in recent months, however each occurrence was a mutual agreement that she and I wouldn't participate in a "penetrating" encounter and it was limited to oral sex. I personally am aware of no such STD that would cause only itching with no other signs (such as rash, fever, etc) that could be contracted from oral sex. However, if that is a point of interest in possible cause, I'd like to know!

Thank you in advance for your assistance and for making it all the way through my wall-of-text of a question. I greatly appreciate it!

(PS - On a side question, if I'm using a topical cream to treat this, is it alright to apply a menthol/lidocane gel a little while later to help soothe itching if it returns?)
Submitted: 2 years ago.
Category: Medical
Expert:  Camille-Mod replied 2 years ago.

Hi, I’m a moderator for this topic and I wonder whether you’re still waiting for an answer. If you are, please let me know and I will do my best to find an Expert to assist you right away. If not, feel free to let me know and I will cancel this question for you. Thank you!

Customer: replied 2 years ago.
Good Afternoon Camille,

I'd like to leave the question open the in the medical category for a few more hours before deciding whether or not to cancel it. I appreciate your concern for finding an expert.

Thank you!
Expert:  Camille-Mod replied 2 years ago.

Thank you :-) Sometimes, finding the right Expert can take a little longer than expected and we thank you greatly for your understanding. We’ll be in touch again shortly

Expert:  Coachrobmd replied 2 years ago.
Camille, I think Dr.Thomas would have some homeopathic remedies that could do this patient a lot of good. It seems the customer has tried a lot of OTC medications and prescriptions as well. Why not refer this case to DrT for a try? I wish the customer luck.
Expert:  Coachrobmd replied 2 years ago.
Sarcoptes scabies is the most likely culprit given the failure or response to therapy to far. Often very little rash, but intensely itchy and at times exclusively located to the groin. I actually had this, which I got when hospitalized for three days for back surgery. It must have been in the linen. This is NOT a disease of the indigent or dirty. It can be picked up a variety of ways (I shower every day, believe me). It drove me NUTS until I did my own scraping to confirm the diagnosis. But it was really itchy and a nightmare to live with. Thank goodness I made the diagnosis.

Read about it here:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001833/

This is diagnosed with a skin scraping or biopsy and is easily treated with the treatment topical Pyrimethamine. This is a prescription medication.

So, this man should see either a dermatologist or a urologist, both of whom can treat this very easily.

If it's NOT scabies, then they should be able to assist, especially the dermatologist. After a while, self-directed therapy is not going to work.

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Coachrobmd, Internal Medicine MD
Category: Medical
Satisfied Customers: 1785
Experience: •Fmr. Dir. Hep. C Clinic. •Fmr. Dir. Head Trauma Rehab Ctr.
Coachrobmd and 4 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Hi Coach Rob,

I appreciate your reply to my question, however it looks like you are under the impression that I've been using prescription products and OTC products for a period of time without results, which isn't the case. I'm only on my second day of treatment with Lotrimin and I use Lidocane gel sparingly for "immediate" need of itch-relief. While I will most certainly consider visiting a dermatologst for this issue, would you recommend I do so right away or should I finish my 2 weeks treatment of OTC Lotramin before taking additional steps? (If it's scabies like you mentioned, I am not sure if there are more severe consequences from waiting 2 extra weeks and would just like like confirmation on your advice.)

I am prepared to accept your answer with your response. Thank you in advance for your assistance!
Expert:  Coachrobmd replied 2 years ago.
If it's scabies, no it doesn't cause long term issues. However, it can spread to others through linens and contact, and that doesn't make you any friends to be sure. And by prescription I mean lotrimin, the active ingredient of which USED to be by prescription only. Sorry if that confused you.

This is not dangerous if you can put up with it. And if you want to continue with lotrimin, this is your decision. I can only give you my best advice.

But if it is me (and it WAS as I described above), then I want an answer to why my scrotum is burning and itching so badly I want to tear it off. Maybe you have a higher tolerance for discomfort than I do. Itching bothers me a lot, so I'm pretty sensitive to that.

So, no problem waiting if you desire. But this is an easy diagnosis with a simple skin scraping and a microscope, so why put it off?

Is there more I can do for you?

==================================
If you find this informative, please click "ACCEPT" so I can receive credit. FOLLOW UP QUESTIONS CAN ALWAYS BE ASKED BY HITTING 'REPLY'. Please take a moment to leave SOME positive feedback.

============================

A BONUS will be appreciated if you found my answer especially helpful. My responses are for information purposes and are not MEANT to replace a physician or ER visit. Future questions? Ask for CoachRobMD in the question title or save my profile to your browser favorites. Here is the link to my JA profile: http://www.justanswer.com/medical/expert-CoachRobMD/
Customer: replied 2 years ago.
Thank you VERY much for your response. I will take all of your advice into consideration before making my next move. I will be accepting your answer now but just wanted to drop you this thank you note. :)

And yes, you're right, it's miserable. I would not wish this catastrophy on my worst enemy and I'm about ready to just rip them off. I'm sorry that you've experienced this as well but I'm glad you were able to relate to the wonder that is insatiable itching and be able to sympathize with my situation to offer the best advice.

Thank you again, have a great day!
Expert:  Coachrobmd replied 2 years ago.
I feel your pain, literally AND figuratively.

But there's hope and a skin scraping will get you where you need to be.

To your good health…
Expert:  Coachrobmd replied 2 years ago.
If you have any follow-up questions about the issue we discussed on JustAnswer.com, or any NEW items that may have come up as a result of my recommendations, please return to the thread (see link below) and add a new question. I'll get an email notifying me that you want more assistance. I'm always happy to help. It's best to have the first line state "FOR COACHROBMD ONLY" so other experts won't become involved. If I don't hear back from you, hopefully everything turned out well.

http://www.justanswer.com/medical/6gfe3-excessive-scrotum-itching-no-rash.html?L=T&r=ems%7C2012-03-30%7C15

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