Prevention and treatment of scrotal eczema and orchitis: essential reading for men's health.

Scrotal Eczema

Scrotal eczema is a common skin condition of the male genitalia. It is not a sexually transmitted disease and is commonly known as "scrotal eczema" or "scrotal fistula." It is quite stubborn. Patients often experience pain or secondary infections due to scratching or inappropriate irritation. This disease is divided into acute and chronic types and is closely related to a person's occupation and living environment. People who work in coal mines, tunnels, or other damp environments for extended periods, or who live in damp areas or rooms, are more prone to this disease. The itching is severe and recurrent.

The causes of scrotal eczema are complex, involving both internal and external factors. People with allergies, those experiencing prolonged stress, or those with significant mood swings are more susceptible to this disease. Additionally, people with certain diseases, such as chronic digestive system diseases, gastrointestinal dysfunction, endocrine disorders, or metabolic disorders, are also more prone to this disease under the influence of external factors. External factors include:
① A damp living and working environment with high air humidity;
② External stimuli, such as cold or heat, excessive sweating, and excessive scratching;
③ Tight underwear, friction from foreign objects, and wearing synthetic fiber underwear can all induce scrotal eczema.

The main subjective symptom of acute scrotal eczema is itching, and patients often discover the disease due to itching of the scrotum. As the condition progresses, the itching gradually worsens, and scratching cannot relieve the itching, severely affecting sleep and work. Skin rash symptoms include: firstly, small papules, vesicles, and small blisters. Densely distributed millet-sized papules or small blisters can be found on the scrotum, with a red base; secondly, exudation and erosion. Due to itching causing scratching, the papules, papulovesicles, and blisters are broken, resulting in continuous serous exudation, often soaking the underwear and forming erosions. In addition, local washing with soapy water and scratching can worsen the skin lesions. Alcohol consumption, insomnia, and stress can also exacerbate the condition. Chronic scrotal eczema, due to its long duration and constant scratching, causes the scrotal skin to become dry, thickened, and wrinkled, resembling a walnut shell, often with thin crusts and scales, and darkened skin pigmentation; however, scratching can also cause hypopigmentation. Intense itching is common, making sleep impossible. Due to the difficulty in treatment and frequent recurrence, scrotal skin may develop eczematous changes.

Diagnosis of scrotal eczema is not difficult. A diagnosis can usually be made based on the characteristics of the skin lesions and the intense itching. Sometimes, it is necessary to differentiate it from neurodermatitis of the scrotum, scrotal itching caused by riboflavin deficiency, and eczematous carcinoma of the extramammary gland.

[Drug Treatment] Since scrotal eczema, like eczema in other parts of the body, is related to allergies, medications used to treat allergies can also be used to treat scrotal eczema. Oral medications such as antihistamines commonly include cyproheptadine 2 mg three times daily; chlorpheniramine 4 mg three times daily; chlorpheniramine 25 mg three times daily; and loratadine 10 mg once daily. Topical medications mainly consist of corticosteroid ointments, such as triamcinolone acetonide ointment, fluocinolone acetonide ointment, and hydrocortisone ointment.

【Lifestyle Management】 Scrotal eczema is a stubborn disease that is difficult to cure, so prevention is essential. Underwear should be loose and comfortable, preferably made of pure cotton; avoid wearing tight underwear. Change underwear frequently, especially after exercise or physical labor. Diet should include plenty of fresh vegetables and fruits, and avoid or minimize consumption of spicy and pungent foods. When experiencing scrotal itching, seek treatment actively; avoid excessive scratching and hot washing, especially with soapy water.

Orchitis

Orchitis is generally classified into the following categories:

One is granulomatous orchitis. This mostly occurs in middle-aged men. The etiology is not yet clear, but patients often have a history of testicular injury. Therefore, it is possible that damage to germ cells leads to the production or release of certain substances that cause granuloma formation. Clinically, it can present with an acute course, with obvious inflammatory swelling and pain in the testis, or it can progress slowly, resembling a testicular tumor. Grossly, the testis is enlarged, the tunica vaginalis shows focal or diffuse thickening, and there is hydrocele. On cut surface, the affected testis appears diffuse or localized grayish-white or yellowish-brown. Microscopic observation reveals damage to the seminiferous tubules, with nodule-like nodules formed by numerous epithelioid cells, lymphocytes, plasma cells, histiocytes, and some multinucleated giant cells and neutrophils. Degenerated sperm are visible in the center of the nodules. Fibrous tissue proliferates around the granulomas, the basement membrane of the seminiferous tubules is thickened fibrously, and the interstitium contains abundant infiltration of lymphocytes and plasma cells, as well as fibrous tissue proliferation.

Secondly, there is mumps-related orchitis. Approximately one-quarter of adults with mumps may develop orchitis, while orchitis is less common in pre-pubertal children. In the acute phase, the affected testis shows interstitial edema and infiltration of neutrophils, lymphocytes, and histiocytes; the seminiferous tubules are dilated, and the lumen also contains neutrophils and lymphocytes. 40%–60% of cases can become chronic, with the disappearance of spermatogenic cells in the seminiferous tubules, infiltration of interstitial lymphocytes, and the occurrence of fibrosis and hyalinization, leading to testicular atrophy and loss of spermatogenesis. This disease is mostly unilateral and does not affect fertility; however, if both testes are involved, it can cause infertility.

Thirdly, there is testicular gumma. Acquired tertiary syphilis can invade the testes. There are two types of lesions: the more common one is gumma; the other is diffuse inflammation and fibrosis. Testicular gumma presents as progressive enlargement of the testis without significant pain. The diameter is generally 1–3 cm, the texture is relatively tough, and the cut surface is yellow, irregular necrotic tissue surrounded by a thick layer of fibrous tissue. Microscopically, traces of the original tissue structure can be seen in the necrotic tissue, and the surrounding fibrous tissue contains a large number of lymphocytes and plasma cells, as well as multinucleated giant cells. Obliterative endarteritis is often seen around gum-like swellings and within small blood vessels. Diffuse inflammation and fibrosis of the testis do not present with significant enlargement. Microscopic examination reveals diffuse fibrosis with abundant infiltration of lymphocytes and plasma cells, and atrophy of the seminiferous tubules.

Fourthly, spermatogenic granuloma. This is caused by epididymal inflammation or trauma damaging the vas deferens, leading to sperm leakage into the interstitium and causing the lesion. Macroscopically, a grayish-white or grayish-yellow nodule, generally 0.5–3 cm in diameter, can be seen at the upper pole of the epididymis. The cut surface shows the nodule containing yellow or brownish-yellow material. Microscopically, the lesions mainly occur in the epididymal interstitium. Early lesions primarily involve infiltration of neutrophils and macrophages, with centrally located or degenerated sperm. Late-stage lesions are tuberculous granulomas composed of epithelioid cells, lymphocytes, and histiocytes, with visible multinucleated giant cells. The center of the granuloma contains degenerated sperm and cellular debris, surrounded by fibroblast proliferation. Finally, the granuloma may be replaced by fibrous tissue, forming hyalinized fibrous nodules. Spermatogenic vas deferens sarcomas may be related to structural obstruction (often associated with a history of vasectomy), often forming multiple indurations on the vas deferens. Its pathological features are similar to epididymitis.

While actively treating the pathogen with anti-inflammatory therapy, bed rest, scrotal elevation, and local cold compresses are recommended during the acute phase. During the chronic phase, moist heat compresses are used to promote absorption. If an abscess forms, incision and drainage are necessary. If the testis is completely destroyed, it may be removed.