Red scrotum syndrome - Anogenital in
White men older than 50 have the highest incidence of this condition, but cases have been reported in younger individuals. Patients commonly present with scrotal erythema and burning pain with a preceding history of topical corticosteroids on the affected area. The average duration of topical corticosteroid use is 27 months, but cases of RSS have occurred after as few as 2 weeks. RSS can develop after prolonged use of topical corticosteroids with a potency as low as over-the-counter hydrocortisone cream. A common complaint is difficulty sitting normally due to pressure on the scrotum causing pain. RSS is a chronic condition that is difficult to treat, which can cause profound psychological distress.
RSS is thought to be part of red burning skin syndrome, which describes other presentations of rebound vasodilation following chronic use of topical corticosteroids, including red face syndrome, red scalp syndrome, red ear syndrome, and red vulva syndrome.
L53.9 – Erythematous condition, unspecified
N50.89 – Other specified disorders of the male genital organs
238969001 – Burning scrotum
65645005 – Scrotal pruritus
Differential Diagnosis & Pitfalls
- Cellulitis – Swelling of the penis or scrotum will be present and may be associated with fever and malaise.
- Contact urticaria – Redness and swelling that last for only a short period of time and is not limited to the anterior scrotum.
- Fixed drug eruption – Will have red patches or plaques that may be vesicular or erosive.
- Scrotal abscess
- Fournier or gas gangrene
- Contact dermatitis – May involve nonscrotal areas; can perform patch testing if suspected.
- Herpes simplex virus or zoster
- Atopic dermatitis – May be signs of atopy and extragenital involvement.
- Inverse psoriasis – Evaluate with histopathological examination if suspected.
- Langerhans cell histiocytosis – Evaluate with histopathological examination if suspected.
- Contact dye dermatitis of the scrotum
- Tinea cruris – Evaluate with potassium hydroxide (KOH) preparation if suspected.
- Seborrheic dermatitis
- Erythrasma – Evaluate with Wood's lamp examination if suspected.
Drug Reaction Data