title: Red scrotum syndrome: idiopathic neurovascular phenomenon or steroid addiction?
abstract: BACKGROUND
  Red scrotum syndrome (RSS) is not infrequent but is often misdiagnosed or underdiagnosed, and seldom reported. The exact etiopathogeneis is still unknown but it almost always follows the prolonged application of topical corticosteroids and is characterised by persistent erythema of the scrotum, associated with severe itching, hyperalgesia and a burning sensation.
  
  
  OBJECTIVE
  To evaluate the clinicoepidemiological profile and assess the efficacy of various treatment modalities in addition to corticosteroid abstinence in the treatment of RSS.
  
  
  METHODS
  Twelve patients with RSS, who presented to us during 2010 and 2011, were identified, and various aspects of their illness and treatment were studied. Patch testing was performed in all patients. A skin biopsy was done in seven patients.
  
  
  RESULTS
  The average age of the patients was 45.83 years (26-62 years). The average duration of illness or the duration of topical steroid use was 27.41 months (6-56 months). Psychiatric comorbidities were seen in 9 (75%) out of 12 patients. Histopathology revealed features resembling erythematotelengiectatic rosacea in four of the biopsied patients. Patch test results were negative. All patients reported improvement of their symptoms within 4 weeks of starting doxycycline with amitriptyline or pregabalin; the treatment had to be continued for 3-4 months.
  
  
  CONCLUSIONS
  RSS appears to be a manifestation of corticosteroid misuse rather than a primary disease. We suggest that RSS is a rosacea-like dermatosis or steroid-induced rebound vasodilation based on clinical and histopathological features. Our patients responded to cessation of steroids and doxycycline in combination with amitryptaline or pregabalin.
authors.affiliation: Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Narang
authors.forename: Muthu Sendhil
authors.initials: MS
authors.lastname: Kumaran
authors.forename: Sunil
authors.initials: S
authors.lastname: Dogra
authors.forename: Uma Nahar
authors.initials: UN
authors.lastname: Saikia
authors.forename: Bhushan
authors.initials: B
authors.lastname: Kumar
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000639:Amitriptyline / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D004890:Erythema / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin; D012189:Retrospective Studies; D012611:Scrotum / Q000187:drug effects / Q000473:pathology*; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D000639:Amitriptyline; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D004318:Doxycycline