Scrotal and Glans Lesions: Causes and Treatments Explained - Urology

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Understanding scrotal and glans lesions can be complex, as there are various potential causes and treatments for such conditions. Based on your description, it seems you are experiencing multiple lesions on the scrotum, which are itchy, and some on the glans that are smaller but persistent. The fact that you have ruled out sexually transmitted infections (STIs) such as HIV, syphilis, and HPV (which causes genital warts) is a positive step, but it does not eliminate other possible diagnoses.


Possible Causes of Scrotal and Glans Lesions
1. Folliculitis: This is an inflammation of the hair follicles, which can lead to small, itchy bumps. It can be caused by bacterial infections, irritation from shaving, or fungal infections.

2. Seborrheic Keratosis: These are benign growths that can appear on the scrotum and other areas of the body. They are usually not itchy and have a characteristic "stuck-on" appearance.

3. Eczema or Dermatitis: Skin conditions like eczema can cause itchy, inflamed patches on the skin, including the genital area. This could explain the itchiness, especially at night.

4. Pearly Penile Papules: These are small, harmless bumps that can appear on the glans and are often mistaken for warts. They are normal anatomical variations and do not require treatment.

5. Lichen Simplex Chronicus: This is a condition caused by chronic scratching or irritation, leading to thickened, itchy skin. It can occur in the genital area and may require treatment to break the itch-scratch cycle.

6. Fungal Infections: Conditions like tinea cruris (jock itch) can cause itchy lesions in the groin area, including the scrotum.

Treatment Options
Given that you have been using a topical medication ("皮大夫" cream) for two weeks with some improvement on the glans but not on the scrotum, it may be time to reassess the treatment plan. Here are some steps you can consider:
1. Consult a Dermatologist: Since the lesions are persistent and have not responded adequately to the current treatment, a referral to a dermatologist may be beneficial. They can perform a more thorough examination and may suggest a biopsy if necessary to determine the exact nature of the lesions.

2. Topical Steroids: If the lesions are due to dermatitis or eczema, a stronger topical steroid may be prescribed to reduce inflammation and itching.

3. Antifungal Creams: If a fungal infection is suspected, antifungal creams can be effective in treating the condition.

4. Avoid Irritants: Ensure that you are using gentle, fragrance-free soaps and avoid any products that may irritate the skin in the genital area.

5. Maintain Hygiene: Keeping the area clean and dry can help prevent further irritation or infection.

6. Monitor Symptoms: Keep track of any changes in the lesions, including size, color, and associated symptoms like pain or discharge, and report these to your healthcare provider.


Conclusion
In summary, while your symptoms may not indicate a serious condition, the persistence and nature of the lesions warrant further investigation. A dermatologist can provide a definitive diagnosis and appropriate treatment plan tailored to your specific condition. It is essential to avoid self-diagnosing and to seek professional medical advice to ensure proper care and management of your symptoms.