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Question
I am having severe itching in my scrotum and groin area for quite some time. Specifically, the skin between the thighs is itchy. There is no fungal infection. The itching become more intense while seated and when getting up from sleep. The area between the legs have become discoloured. It appears greyish-white. I applied turmeric mixed with honey to the affected area and noticed some improvement in the itching. I need a solution for this problem.
Answer
Genital or scrotal itching (“pruritus” – Latin term for itching) of recent onset is often caused by infections, allergies or irritation due to a physical object. This usually resolves with a short term therapy. In a number of patients, no underlying disease can be identified and the condition is termed “pruritus of undetermined origin”.
In the given scenario the duration of the illness seems to be longstanding. Therefore, this may be due to causes other than infections or allergies. Nevertheless, it is worthwhile to rule out some of the infections which can persist for long time. For instance, fungal infection; commonly known as jock itch, often affects genital area and may not resolve easily. This can be confirmed or excluded by taking a skin scraping sample and examining under the microscope.
Other possible causes are psoriasis, lichen sclerosus and irritation of the lower spinal nerves (lumbosacral radiculopathy). Very rarely lichen simplex, lichen planus and skin cancer can be implicated as a cause of itching.
Jock itch (tinea cruris) causes a red and itchy rash and it often affects the groin and inner thighs. Jock itch gets its name because it’s common in athletes. It is also common in people who sweat a lot or who are overweight. Keeping the area dry, wearing loose fitting-clean clothes and not sharing personal items such as damp towel, can alleviate this infection. Sometime applying an antifungal cream would help.
Psoriasis is an autoimmune condition which means our immune cells are acting against some of our own body cells or skin cells in this case. They can be extremely itchy and difficult to get rid of. In case of psoriasis, similar looking rashes may be present in some other areas of the body. This can be treated with steroid creams or ointments which can modulate the immune system.
Lichen sclerosus is a common skin condition mostly affecting people above the age of 50 years. It affects non-hair bearing skin areas such as tip of the penis and it does not usually affect people who were circumcised at young age. In the above patient, the exact area of skin involvement is not clear. Therefore, it is difficult to predict whether lichen sclerosis is a possible alternative diagnosis in this case. This condition is often diagnosed by careful examination of the affected skin but a skin biopsy may be required. Skin biopsy means; taking a pinch of tissue from the affected skin and examining under the microscope. Remedies includes; washing with non-soap cleansers, avoiding tight clothing and discontinuing any aggravating activities such as riding a bicycle. Application of steroid creams may help.
Pin worm can infest the lower part of the gut. They lay eggs in the skin around the anus. This can cause itching in the perianal region and sometimes the itching can involve scrotal skin as well. Taking a course of oral anti-worm treatment would help.
The nerves originating from the lower part of the spinal cord are named; lumbar and sacral nerves. When the nerves are irritated due to any reason, this can give rise to pain, tingling sensation and itching in the genital area and inner thighs. Cause of nerve irritation can be spinal injuries, compression by a slipped disc, tumours or infections. Treatment of this condition can be challenging and mostly undertaken by Neurologists or Orthopaedic specialists.
In any skin condition it is important to examine the affected area. The pattern of skin changes will usually give a clue about the diagnosis. This has to be complemented with through details about the onset, progression and pattern of skin involvement.
Turmeric has been tested for various skin condition including itching. There have been some positive results although the evidence is lacking. Likewise, bee honey has been experimented for variety of medical conditions. There seems to be some benefit for eczema or allergic skin rash.
In summary, the scrotal itching can be due a number of causes. It is important to ascertain the exact cause for successful treatment. Nevertheless, there won’t be a recognisable cause in a significant proportion of patients. In such situations, an anti-histamine (anti-allergy medications) can be taken as long as required.
Author: Suhail
References
- Alexander, Christopher E., and Matthew Varacallo. 2020. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430837/.
- Cohen, Arnon D, Tatiana Vander, Evgeny Medvendovsky, Amnon Biton, Sody Naimer, Raquel Shalev, and Daniel A Vardy. 2005. “Neuropathic scrotal pruritus: anogenital pruritus is a symptom of lumbosacral radiculopathy.” J Am Acad Dermatol 61-66. doi:10.1016/j.jaad.2004.04.039.
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- Oakley, Amanda. 2016. Lichen sclerosus. January. Accessed June 01, 2020. https://dermnetnz.org/topics/lichen-sclerosus/.
- Vaughn, Alexandra R, Amy Branum, and Raja K Sivamani. 2016. “Effects of Turmeric (Curcuma Longa) on Skin Health: A Systematic Review of the Clinical Evidence.” Phytother Res 1243-1264. doi:10.1002/ptr.5640.
- Weisshaar, Elke. 2008. “Successful Treatment of Genital Pruritus Using Topical Immunomodulators as a Single Therapy in Multi-morbid Patients.” Acta Dermato-Venereologica 195-196. doi:10.2340/00015555-0410.
