The scrotum of an adult is relatively immune to dermatophyte infection, but it is a favorite site for circumscribed neurodermatitis (lichen simplex chronicus) (Fig. 4-5). Psychogenic pruritus is probably the most frequent type of itching seen. Why it preferentially affects this area, or in women the vulva, is unclear. Lichenification may result, be extreme, and persist for many years despite intensive therapy.
Infectious conditions may complicate or cause pruritus on the scrotum but are less common than idiopathic scrotal pruritus. Fungal infections, except candidiasis, usually spare the scrotum. When candidal infection affects the scrotum, burning rather than pruritus is frequently the primary symptom. The scrotum is eroded, weepy, or crusted. The scrotum may be affected to a lesser degree in cases of pruritus ani, but this pruritus usually affects the midline, extending from the anus along the midline to the base of the scrotum, rather than the dependent surfaces of the …Figure not available in preview mode