Fee-Basis Hospitalist, North Texas VA Medical Center, 4500 South Lancaster Road, TX, 75216, Dallas, USA.
Eur J Med Res. 2021 Aug 19;26(1):95. doi: 10.1186/s40001-021-00569-9.
Red scrotum syndrome is typically described as well-demarcated erythema of the anterior scrotum accompanied by persistent itching and burning. It is chronic and difficult to treat and contributes to significant psychological distress and reduction in quality of life. The medical literature surrounding the condition is sparse, with the prevalence likely under-recognized and the pathophysiology remaining poorly understood. Formation of a cutaneous microbial biofilm has not been proposed as an underlying etiology. Microbial biofilms can form whenever microorganisms are suspended in fluid on a surface for a prolonged time and are becoming increasingly recognized as important contributors to medical disease (e.g., chronic wounds).
A 26-year-old man abruptly developed well-demarcated erythema of the bilateral scrotum after vaginal secretions were left covering the scrotum overnight. For 14 months, the patient experienced daily scrotal itching and burning while seeking care from multiple physicians and attempting numerous failed therapies. He eventually obtained complete symptomatic relief with the twice daily application of 0.8% menthol powder. Findings in support of a cutaneous microbial biofilm as the underlying etiology include: (1) the condition began following a typical scenario that would facilitate biofilm formation; (2) the demarcation of erythema precisely follows the scrotal hairline, suggesting that hair follicles acted as scaffolding during biofilm formation; (3) despite resolution of symptoms, the scrotal erythema has persisted, unchanged in boundary 15 years after the condition began; and (4) the erythematous skin demonstrates prolonged retention of gentian violet dye in comparison with adjacent unaffected skin, suggesting the presence of dye-avid material on the skin surface.
The probability that microorganisms, under proper conditions, can form biofilm on intact skin is poorly recognized. This case presents a compelling argument for a cutaneous microbial biofilm as the underlying cause of red scrotum syndrome in one patient, and a review of similarities with other reported cases suggests the same etiology is likely responsible for a significant portion of the total disease burden. This etiology may also be a significant contributor to the disease burden of vulvodynia, a condition with many similarities to red scrotum syndrome.
红斑阴囊综合征通常表现为阴囊前部边界清晰的红斑，伴有持续的瘙痒和灼热感。它是慢性的，难以治疗，会导致严重的心理困扰和生活质量下降。该病症的医学文献很少，其患病率可能被低估，病理生理学仍知之甚少。尚未提出形成皮肤微生物生物膜是其潜在病因。只要微生物在表面的液体中长时间悬浮，就会形成微生物生物膜，并且它们越来越被认为是导致许多医学疾病（例如慢性伤口）的重要原因。
一名 26 岁男性，一夜之间阴囊上残留阴道分泌物后，双侧阴囊突然出现边界清晰的红斑。14 个月来，该患者每天都感到阴囊瘙痒和灼热，他曾多次寻求多位医生的治疗并尝试了多种治疗方法，但均未成功。最终，他通过每天两次应用 0.8%薄荷醇粉，获得了完全的症状缓解。支持皮肤微生物生物膜是潜在病因的发现包括：（1）该病是在典型的有利于生物膜形成的情况下开始的；（2）红斑的边界精确地沿着阴囊的发际线，这表明在生物膜形成过程中毛囊充当了支架；（3）尽管症状已经缓解，但阴囊红斑仍持续存在，在发病 15 年后边界仍无变化；（4）与相邻未受影响的皮肤相比，红斑皮肤对龙胆紫染料的保留时间明显延长，这表明皮肤表面存在对染料具有亲和力的物质。
在适当的条件下，微生物在完整的皮肤表面形成生物膜的可能性尚未得到充分认识。本病例有力地证明了微生物生物膜是导致红斑阴囊综合征的潜在原因，对其他报道病例的回顾表明，相同的病因可能是导致该疾病总负担的很大一部分的原因。这种病因也可能是导致阴痛（与红斑阴囊综合征有许多相似之处）疾病负担的一个重要因素。
