Ann Dermatol.  2019 Jun;31(3):320-324. 10.5021/ad.2019.31.3.320.

Red Scrotum Syndrome Treatment with Pregabalin: A Case Series

• Cardenas-de la Garza JA
• Villarreal-Villarreal CD
• Cuellar-Barboza A
• Cardenas-Gonzalez RE
• Gonzalez-Benavides N
• Cruz-Gomez LG
• Ocampo-Candiani J
• Welsh O

• KMID: 2444865
• DOI: http://doi.org/10.5021/ad.2019.31.3.320

Abstract

Red scrotum syndrome (RSS) (also known as male genital dysesthesia) is a rarely recognized entity characterized by scrotal erythema accompanied by a burning sensation, pain, hyperesthesia/dysesthesia, increased temperature and pruritus. Although its physiopathology is unknown, it has increasingly been associated with chronic topical steroid use in the male genital area. Treatment is challenging and no standardized treatment is currently available. Because current treatment relies on case reports and small case series, the need for more information about drug efficacy in RSS is warranted. The aim of this study is to describe the therapeutic response to pregabalin in patients from an outpatient dermatologic clinic in a tertiary-care hospital diagnosed with RSS. Five patients with a confirmed diagnosis of RSS were included. Ages ranged from 28 to 63 years. All patients had chronic steroid use in the genital area, mostly in the form of combined formulations of corticosteroids, antifungals, and antibiotics. Four patients were prescribed pregabalin monotherapy, 150 mg once daily at night. One patient was prescribed pregabalin and doxycycline. Two patients had complete remission after one month of therapy, one at two months and two at three months. None experienced recurrence at an average of 9.4 months' follow-up. One patient experienced morning drowsiness that did not require suspending treatment. Pregabalin is a well-tolerated and effective treatment for RSS.

Keyword

Doxycycline; Erythromelalgia; Genital dysesthesia; Neurogenic inflammation; Pregabalin; Red scrotum syndrome

MeSH Terms

Adrenal Cortex Hormones
Anti-Bacterial Agents
Burns
Diagnosis
Doxycycline
Erythema
Erythromelalgia
Follow-Up Studies
Humans
Male
Neurogenic Inflammation
Outpatients
Pregabalin*
Pruritus
Recurrence
Scrotum*
Sensation
Sleep Stages
Adrenal Cortex Hormones
Anti-Bacterial Agents
Doxycycline
Pregabalin

Figure

• 

  Fig. 1 Case 4. After betamethasone, gentamicin, and clotrimazole cream employed for 2 months.

• 

  Fig. 2 Case 4. Complete symptom remission after 1 month of treatment.

Reference

1. Narang T, Kumaran MS, Dogra S, Saikia UN, Kumar B. Red scrotum syndrome: idiopathic neurovascular phenomenon or steroid addiction? Sex Health. 2013; 10:452–455.

2. Abbas O, Kibbi AG, Chedraoui A, Ghosn S. Red scrotum syndrome: successful treatment with oral doxycycline. J Dermatolog Treat. 2008; 19:1–2.

3. Fisher BK. The red scrotum syndrome. Cutis. 1997; 60:139–141.

4. Miller J, Leicht S. Pregabalin in the treatment of red scrotum syndrome: a report of two cases. Dermatol Ther. 2016; 29:244–248.

5. Wollina U. Three orphans one should know: red scalp, red ear and red scrotum syndrome. J Eur Acad Dermatol Venereol. 2016; 30:e169–e170.

6. Byun JW, Hong WK, Han SH, Song HJ, Lee HS, Choi GS, et al. Red scrotum syndrome: successful treatment with oral doxycycline. Int J Dermatol. 2012; 51:362–363.

7. Merhi R, Ayoub N, Mrad M. Carvedilol for the treatment of red scrotum syndrome. JAAD Case Rep. 2017; 3:464–466.

8. Prevost N, English JC 3rd. Case reports: red scrotal syndrome: a localized phenotypical expression of erythromelalgia. J Drugs Dermatol. 2007; 6:935–936.

9. Wollina U. Red scrotum syndrome. J Dermatol Case Rep. 2011; 5:38–41.

10. Rapaport MJ, Rapaport VH. Serum nitric oxide levels in “red” patients: separating corticosteroid-addicted patients from those with chronic eczema. Arch Dermatol. 2004; 140:1013–1014.

11. Rapaport M. Rebound vasodilation from long-term topical corticosteroid use. Arch Dermatol. 2007; 143:268–269.

12. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015; 14:162–173.

13. Wang BC, Liu D, Furnback WE, Bifa F, Dong P, Xie L, et al. The cost-effectiveness of pregabalin versus gabapentin for peripheral neuropathic pain (pNeP) and postherpetic neuralgia (PHN) in China. Pain Ther. 2016; 5:81–91.

14. Toth C. Pregabalin: latest safety evidence and clinical implications for the management of neuropathic pain. Ther Adv Drug Saf. 2014; 5:38–56.