Dermatological Diseases Specific to Scrotum

Abstract

Most scrotal dermatological pathologies are discovered by the patient and are initially attributed to be a venereal diseases, usually evaluated by a thorough physical examination and few investigations. The clinician facing a patient with scrotal dermatosis must consider a wide differential diagnosis based on the diverse range of etiologies. Urologists are often the first point of contact for patients with such disorders, but many patients may be referred to dermatologists. Scrotal dermatosis may be an isolated genital conditions or a manifestations of a more widespread general cutaneous disease. In general, genital dermatoses can be classified as physiologic variants, inflammatory, immunological, or infectious lesions. Infections diseases are quite common in the genital area due to several factors. With a two body orifices being anatomically located in close relation, and the anatomical microstructure of genital skin which differs in its architecture and elasticity from skin of other body sites these keeping the scrotum more vulnerable to a wide range of dermatosis. Genetically the androgen and estrogen receptors are highly expressed in genital skin. So genital wound repair benefits from hormonal responsiveness and increased presence of sex steroid hormones due to intracrine production by skin cells. Chronic inflammatory conditions caused by autoimmune disorders, infections, or foreign material can lead to severe tissue fibrosis followed by shrinkage and destruction of the outer genitalia. Without appropriate treatment, scrotal skin may develops scaring or even fistulas with recurrent infections and subsequent scarring of its wrinkles. Several skin diseases with autoimmune background can affect the outer genitalia with chronic inflammation leading to tissue shrinkage and atrophy. The genital skin has to master many challenges, for example, the fast volume changes during sexual activity, sex steroid sensitivity with permanent hormonal changes, the presence of several body openings with constant commensal microbial presence, and infectious threats derived from sexual contacts. In that context, it is breathtaking to understand the extraordinary adaption of the genital skin to its multiple tasks. In this chapter, some common dermatological diseases affecting the scrotum and their influence on genitalia will be elucidated. Specific pathologies like scrotal calcinosis, lymphedema and other vascular malformations are discussed separately in allocated chapters, also scrotal involvement by other specific sexually transmitted diseases are beyond the scope of this book.