Scrotal Redness and Ulcers: Causes and Concerns

Q: Scrotal Redness and Ulcers: Causes and Concerns

Hello： It is more likely that the skin is not kept clean and dry. <br>There is no need to use panty liners; instead, wear loose-fitting and breathable underwear. <br>Avoid using soap or body wash; just use clean water twice a day. <br>After washing, make sure to dry the area thor

There is slight redness and ulceration on the scrotum?

Hello, doctor.
I previously had a urinary tract infection, and my condition has improved but is not fully healed (I still occasionally experience mild stinging in the urethra).
The examination reports are normal (both urinalysis and bacterial culture are normal).
During the treatment for the urinary tract infection, I used many different types of antibiotics, and later I developed a small ulcer at the back of the glans.
The doctor said it was an allergic reaction to sulfonamide antibiotics (specifically, Sulfamethoxazole), so the medication was discontinued.
After about one to two weeks, I improved.
During this period, I used panty liners out of concern, and I am unsure if this is the reason I developed eczema on the foreskin.
The doctor prescribed Clobetasol and Betamethasone for me to apply.
After a while, I noticed small white spots on the right side of the scrotum.
Initially, I thought it was sebaceous gland obstruction (as the doctor suggested), so I didn't pay much attention.
However, since they looked unusual, I applied Clobetasol to the white spots on the right scrotum.
They don't seem like sebaceous glands because they become particularly white and swollen when wet, resembling a fungal infection on the scrotum, but it shouldn't be because they are not painful or itchy and only appear on the right side of the scrotum.
I didn't pay much attention until a few days ago when I noticed that the area above these white spots (on the scrotum) started to become red and slightly ulcerated.
I cannot think of the cause, but I suspect it could be due to the panty liners, antibiotic allergy, or steroid cream allergy.
I had taken Clindamycin before, and I wonder if this type of antibiotic could cause scrotal ulceration as a drug allergy? Yesterday, I visited a dermatologist who suspected that I might have scratched the area, but I have not scratched it.
The doctor did not mention any issues with the white spots.

1.
Could you provide your opinion based on this description?
2.
Is it possible that these white spots could be genital warts? (I have noticed them for almost a month now, and they do not seem to have increased in number or size.)
Current condition: I had a urinary tract infection six months ago, and I have not fully healed, but all examination reports are normal.
Tests for sexually transmitted infections were also done after the incubation period and were normal.
Thank you.

Da Tian, 30~39 year old female. Ask Date: 2017/06/21

Dr. Du Shixi reply Urology

Hello: It is more likely that the skin is not kept clean and dry.
There is no need to use panty liners; instead, wear loose-fitting and breathable underwear.
Avoid using soap or body wash; just use clean water twice a day.
After washing, make sure to dry the area thoroughly.
You can use povidone-iodine for disinfection twice a day at most.
Avoid alcohol and spicy foods.
If there is no improvement in 2-3 days, you should seek medical attention (it may be an infection).
Medications that cause scrotal ulcers are rare.
Additionally, if it is genital warts, a doctor can usually diagnose it with a glance.
There is no need to worry too much.

Reply Date: 2017/06/21

More Info

Understanding scrotal redness and ulcers can be quite complex, especially in the context of previous urinary tract infections (UTIs) and antibiotic treatments. Based on your description, it seems you are experiencing a combination of symptoms that could stem from several potential causes.

Firstly, the redness and ulceration on the scrotum could be a result of a few different factors. Given your history of a urinary tract infection and subsequent treatment with various antibiotics, it is possible that you may have developed a sensitivity or allergic reaction to one of the medications, particularly sulfonamides, which you mentioned. Allergic reactions can manifest in various ways, including localized skin reactions such as redness, swelling, and ulceration.

Additionally, the presence of white spots on the scrotum that you initially thought were sebaceous gland blockages could indicate a condition known as sebaceous cysts, which are generally harmless. However, if these spots have changed in appearance or have become associated with redness and ulceration, it may suggest a secondary infection or irritation, possibly exacerbated by the use of topical steroids like clobetasol (臨得隆) or other medications.

The concern regarding the use of pads is also valid. If the pads are causing moisture retention or friction, they could contribute to skin irritation, leading to conditions such as dermatitis or fungal infections. Fungal infections can often present with redness and scaling, and while they typically cause itching, not all cases do.
Regarding your question about whether the white spots could be genital warts (菜花), it is important to note that genital warts are caused by the human papillomavirus (HPV) and typically present as small, flesh-colored or gray growths that can appear in clusters. If the spots you are observing do not resemble typical warts and have not changed significantly in size or number, they are less likely to be warts. However, it is essential to have any new or changing lesions evaluated by a healthcare professional for accurate diagnosis and management.

In terms of your ongoing symptoms, including the mild urethral discomfort, it is crucial to continue monitoring your condition. Even though your urine tests and cultures have returned normal, persistent symptoms may warrant further investigation. Conditions such as chronic prostatitis or interstitial cystitis could be considered, especially if there is no clear infectious cause.

To summarize, the redness and ulceration on your scrotum could be due to a combination of allergic reactions, skin irritation, or possibly a secondary infection. The white spots may be benign but should be monitored for any changes. It is advisable to follow up with your dermatologist or urologist for a thorough examination and possibly a biopsy if there is any uncertainty regarding the nature of the lesions. They may also consider patch testing to evaluate for any allergic reactions to medications or topical treatments you have used.

In conclusion, while your symptoms may be concerning, many potential causes are manageable with appropriate medical care. It is essential to maintain open communication with your healthcare providers and seek further evaluation if your symptoms persist or worsen.

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