Dermatologist Discusses Genital and Anal Itching

Hi Dr. Bailey,

I have an ongoing problem. My scrotum and groin on both sides are very itchy. It’s worse at night. I have already seen a dermatologist. She recommended Zeasorb. I do not want to use this powder because it contains a carcinogen: acrylamide. Any suggestions for a substitute powder or gel?

Steve

Dear Steve,

Itching of the genital and anal skin is really common, but people don’t often talk about it. Thanks for sending in this question.  It brings up an interesting topic that was presented at the Itch Forum at the American Academy of Dermatology’s annual meeting last month and that I want to discuss. This discussion covers general information, and I’m not saying that it pertains to your situation, but it’s interesting and would be worth bringing into your dermatologist and letting them decide if it might be relevant to your problem.

The condition is scrotal and genital pruritus (pruritus means itch). It’s now well accepted that this problem is usually due to spinal nerve root impingement in the lumbar or sacral part of the spine. The lumbosacral nerve impingement causes the itch because nerves from this part of the spine supply the skin of the genital area. They go to the anal area too, so impingement of these nerves may instead manifest as itch around the anus. Nerves from the same spinal area also supply the feet, so the itch could instead be there.

When skin itches due to a nerve that isn’t actually in the skin, the itch is called neuropathic pruritus, meaning the sensation of itch is actually due to the nerve, not the skin.  The common areas for neuropathic skin itch are:

I’ve covered the back and arm itch in prior posts, and your question inspires me to complete the information for these final sites.

The standard treatment for neuropathic itch in the genitalia is an oral medicine that works on the nerve signals. This medicine does have side effects, so any person interested in this medicine needs to be under the care of their treating physician. Because the nerve root impingement is potentially chronic, the treatment could go on indefinitely.

With my patients I tend to want to exhaust all non-oral treatments first. Another speaker at the same lecture series was a dermatologist expert in natural/alternative therapies. He advocated using acupuncture and biofeedback for chronic itch syndromes. Over the years my patients have had good responses to both therapies for both neuropathic pain (e.g. shingles) and neuropathic itch.

I treat a lot of patients with genital and anal pruritus and I always have them bathe the affected skin twice a day and use hypoallergenic care for their undergarments. This alone often gives them complete relief from the itch. It doesn’t change the nerve root impingement, but it works anyway, and it’s sure harmless. Specifically, I have them take twice daily showers or baths with warm, not hot, water and use a gentle, non-allergenic soap, such as Whole Foods unscented 356 glycerin bar or Vani Soap to clean their skin. For their undergarments, I recommend wearing only soft cotton underwear and washing them in hypoallergenic laundry soap (Cheer Free or All Free and Clear) and rinsing twice. No antistatic products (fabric softener or dryer sheets) should be used because they leave a potentially allergenic residue on fabric.

Please remember, that I’m not making a diagnosis and not saying that any of this information pertains to your specific problem. Your question inspired this discussion and the information may be interesting for you and your treating dermatologist to discuss. There are many diagnoses that can cause genital itching, including but not limited to, fungal infection, allergic contact allergy, psoriasis, seborrheic dermatitis, etc. All treatment starts with an accurate diagnosis, so you need to find a dermatologist where you live who can diagnosis and treat you in a way that you are comfortable with.

Warm Regards,
Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

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