Authors: Nicole S. Kim, Medical Student, University of Toronto, Canada; Dr Yuliya Velykoredko, Dermatology Resident, University of Toronto, Canada. DermNet NZ Editor-in-Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. September 2018.
Lichen simplex of the scrotum is a pruritic form of dermatitis in which excessive scratching or rubbing leads to lichenification. Characteristically, there are well-demarcated, erythematous or hyperpigmented plaques with marked skin thickening on one or both sides of the scrotum. Lichen simplex is typically secondary to an underlying skin condition or neuropathy causing extreme itch.
Lichen simplex is also known as lichen simplex chronicus and neurodermatitis. Lichen simplex of the scrotum is also known as lichen simplex of the male genitalia and wash leather scrotum [1,2,3,5].
Lichen simplex of the scrotum is most often diagnosed in males between the ages of 35 and 50 years .
Lichen simplex of the scrotum is attributed to a persistent itch-scratch cycle. Underlying pruritus, a cutaneous or systemic condition, or a neuropathy or psychiatric disorder can induce intractable scratching that leads to hypertrophy of the scrotal skin. Contributing factors to scrotal lichen simplex may include [1,2,3,5]:
Lichen simplex of the scrotum manifests with clearly demarcated thickening of the scrotal skin with hypo- and/or hyperpigmentation and variable scale. It is often unilateral but it may also be bilateral. Coalescing papules form solitary or multiple plaques. Other features may include:
Signs of an underlying skin disorder may also be noted adjacent to lichen simplex of the scrotum and/or on another body site.
More areas of lichen simplex may also be found, commonly the neck, the scalp, the extensor surfaces of extremities, or the lower legs/ankles [1,2].
Complications of lichen simplex of the scrotum may include:
Lichen simplex of the scrotum has also been suspected of contributing to reduced fertility .
Adverse effects from treatment can also arise, particularly atrophy due to extended use of a potent topical corticosteroid on the normally thin scrotal skin. Topical steroids can also cause pigmentation abnormalities [2,5].
The clinical features of scrotal lichen simplex are generally sufficient to establish the diagnosis. When findings are atypical, further tests can be considered to make a definitive diagnosis or to exclude other similar dermatoses.
If the scrotal lichen simplex is associated with generalised pruritus, a work-up for systemic causes can be undertaken as outlined on our pruritus page.
Other disorders that should be considered in a patient with lichen simplex of the scrotum include [1,2,3]:
The main goals of treatment for scrotal lichen simplex are:
Short-term use of topical corticosteroids are used first line to break the itch-scratch cycle. Treatment principles include using a medium potency topical steroid such as triamcinolone ointment until there is resolution of active lesions. If the disease is refractory after 2–3 weeks of intermediate-strength corticosteroid, more potent topical steroids can be used on a short-term basis. As the condition improves, application frequency and potency of the corticosteroid should be decreased to minimise their adverse effects [3,4].
Aim to repair the barrier function of skin with frequent application of emollient creams and moisturisers. Minimise environmental triggers such as:
Identify and treat underlying disorders that cause or worsen scrotal lichen simplex [2,3,4,5].
The clinical course of scrotal lichen simplex is chronic and protracted, and patients may suffer indefinitely without appropriate treatment. As recurrences occur during psychological stresses or flareup of underlying dermatoses, long-term management may be required in some patients .
Hendry WF, Munro DD. "Wash leather scrotum" (scrotal dermatitis): a treatable
cause of male infertility. Fertil Steril. 1990 Feb;53(2):379-81. PubMed PMID:
See the DermNet NZ bookstore.
© 2018 DermNet New Zealand Trust.
DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.