Scrotal pruritus L29.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 21.06.2022

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Genital Pruritus; itching of the scrotum; itchy scrotum; Testicular itching

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Itching of the scrotum is a common, polyetiological, acute or chronic or chronic-recurrent symptom that significantly reduces the quality of life of the affected person by interfering with the daily routines of life (Köhn M et al. 2018). In the case of acute itching, the triggering cause can usually be found quickly. In the case of chronic itching, a careful anamnesis must be taken in order to better understand the correlations.

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  • Candidiasis of the genital region
  • Pediculosis pubis
  • Tinea inguinalis
  • Localized scabies
  • Condylomata acuminata
  • Oxyuriasis

Underlying dermatological diseases with itching

  • Allergic contact dermatitis
  • Toxic contact dermatitis (excessive cleanliness)
  • Atopic eczema (also as a minus variant)
  • Lichen planus
  • Intertrigo
  • Psoriasis (intertriginous psoriasis, also isolated)
  • Pemphigoid bullous (rare)
  • Dyskeratosis follicularis (rare)
  • Pemphigus chronicus benignus familiaris
  • Lichen sclerosus et atrophicus
  • Urticaria

Metabolic and endocrine disorders

  • Diabetes mellitus (see also Diabetes mellitus skin changes)
  • Kidney diseases (especially dialysis patients)
  • Liver diseases (bilirubin elevations)
  • Hyper/hypothyroidism (see also thyroid diseases, skin changes)
  • Hypovitaminosis (especially B6 deficiency; pellagra with pellagroid scrotal dermatitis)
  • Other systemic diseases
  • Iron deficiency anemia
  • Polycythemia vera
  • Hodgkin's disease

Psychogenic factors:

  • Psychogenic factors (defensive or desirable symptom).
  • Pruritus scroti as a sign of somatoform disorder.


  • Pruritus scroti in urinary and/or fecal incontinence.
  • Pruritus in age-related involution processes (so-called senile pruritus)
  • Pruritus in lumbosacral radiculopathy (radiological and neurological clarification - measurement of nerve conduction velocity - Cohen A et al. 2005)
  • Pruritus in case of increased mechanical and/or thermal stress (continuous running, longer walks)
  • Anal fissures
  • Fistulas
  • Inflammatory bowel disease
  • Extramammary Paget's Disease (Cervantes J et al 2018).

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The causes are manifold and include localized skin diseases on the one hand, polytopic skin diseases with involvement of the genitals (scrotum) on the other hand or general systemic diseases with pruritus (e.g. diabetes mellitus, chronic kidney and liver diseases or neurological diseases). In the case of pruritic internal systemic diseases, however, it is rather rare that the itching is limited to the male genitals. Ultimately, psychosomatic illnesses come into consideration.

Clinical features
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Scratching in the scrotal area leads, regardless of the cause, very quickly to erythema, and in the case of permanent scratching to lichenification with thickening of the scrotal skin. Roundish and striated excoriations may appear in the area of the scrotum as well as in the crotch, often passing over to the thighs.

Often the clinical findings are discreet. There are blurred redness, excoriations with crusts, fine lamellar scaling. If the intense itching persists for a longer period of time, lichenenification of the scrotal skin may occur.

Chronic Dermatitis: Most frequently it was a toxic contact dermatitis, caused by chronic irritations, e.g. urinary and/or faecal incontinence, by frequent excessive washing with detergents, by the use of cosmetics, perfumes, disinfectants, etc.

Pruritus scroti and possibly scrotal soreness are increasingly common among long-distance runners and triathletes. Pruritus can also develop after long summer walks. This is caused by increased sweating and prolonged mechanical irritation. Furthermore, the wearing of unsuitable briefs should be avoided, the cut of which does not prevent direct contact between the scrotum and the inner sides of the thigh (e.g. wide boxer shorts).

Inserts for incontinence or condoms are also possible contact noxae. Occlusive effects caused by tight-fitting clothes are also a trigger (Chan MP et al. 2015).

Atopic dermatitis: Often a (localized) atopic dermatitis is the cause of a pruritus in the genital area. The lichen simplex chronicus can also be the cause.

Contact allergic dermatitis: Serious allergens in male genital itching are clothing, underwear and their additives e.g. dyes. Dark colours in particular can trigger allergic reactions, as can fragrances in moist toilet paper or detergents.

Infections: A further cause of scrotal itching is infections with yeast fungi (mostly Candida albicans) and filamentous fungi. Furthermore, crabs and a scabies must be excluded.

Senile atrophy of the scrotum: Age involutions of the scrotum can lead to a considerable parchment-like atrophy of the scrotal skin with exsiccosis pruritus and fine-lamellar scaling (Berger TG et al. 2013).

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The therapy depends on the underlying cause (see also genital eczema). In case of toxic or allergic dermatitis, short-term therapy with a class II glucocorticoid will be useful. Itching caused by the infection requires specific therapy (antimycotic, antiscabial). In senile scrotal atrophy, consistent oily care is recommended as well as the avoidance of irritations of any kind (Kantor GR 1990). In cases of systemically triggered itching, interdisciplinary medical care is required, which usually leads to clarification and successful therapy. Somatoform disorders should also be considered.

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In the case of puritus scroti, attention should also be paid to diseases of the glans penis (balanitis), and also to a disease of the inner preputial leaf (posthitis). In the area of the glans penis, attention should always be paid to the presence of lichen sclerosus et atrophicus, zoon balanitis or candidabalanitiis.

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  1. Berger TG et al (2013) Pruritus in the older patient: a clinical review. JAMA 310:2443-2450.
  2. Cervantes J et al (2018) Enlarging bump on the scrotum. Skin Appendage Disord 5:52-55.
  3. Chan MP et al (2015) Vulvar dermatoses: a histopathologic review and classification of 183 cases. J Cutan Pathol 42: 510-518
  4. Cohen A et al (2005) Neuropathic scrotal pruritus: anogenital pruritus is a symptom of lumbosacral radiculopathy. J Am Acad Dermatol 52:61-66

  5. Kantor GR (1990) What to do about pruritus scroti. Postgrad Med 88:95-96

  6. Köhn M et al (2018) IN: G. Plewig et al (eds), Braun-Falco`s Dermatology, Venereology and Allergology. Springer Reference Medicine p.1504
  7. Surani A et al (2018) Multiple pruritic plaques on scrotum-what is your diagnosis? Indian J Sex Transm Dis AIDS 39:141-142.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 21.06.2022