Dear Dr. G,

Thank you so much for answering my query. I really hope you can help.

I am a 25 year-old man who has been experiencing problems with itchy balls (Sorry for the crudeness). When it itches, it is really bad. I really cannot resist the desire to scratch. Sometimes it even bleeds.

I have been seeing the doctors, who initially said it is fungal infections, and treated

me with antifungal.

Despite two weeks of medicine and ointment, there has been no improvement with the itchiness. In fact it has got worse.

I went back to see the doctor and he said it might be due to me being overweight and over sweaty. Hence the hygiene (or lack of it) is to be blame.

I was told to resist scratching! I don’t mean to be rude, but seriously? When the itch comes, how to resist? Easier said than done, right?

I don’t mean to put Dr. G on the spot, but surely there are quicker ways to fix my itchy balls. Besides, the roughness of the scrotal skin is really ugly and unsightly?

Can you please tell me what can be the causes of my itchy balls? Please help.

Itch Itch.

The itchiness of the scrotal skin, or delicately described as itchy balls by many, is a very common condition amongst men of all ages. The crotch area in men is considered a moist and warm place that can harbor pathogens such as fungus.

Such skin infection is often referred to as Jock itch. This itchy skin complaint is also known as tinea cruris, results in constant overwhelming itch of the scrotum, and the compelling desire to scratch.

Tinea cruris is a fungal skin infection affecting the scrotum and adjacent skin caused by the funguses such as Trichophyton rubrum and epidermophyton floccosum.

This skin infection is highly contagious and can be transmitted by contaminated towels or hotel bedroom sheets. Other risk factors also include poor hygiene and tight fitting undergarment.

Moreover, the infections can be self-induced from a reservoir on the hands and feet.

In the United States, Jock Itch accounts for nearly 20% of all visits to the dermatologists, and it is known to be three times more common in men.

Adults are affected by tinea cruris more than children, especially the ones who are overweight and suffering from diabetes. Of course, such skin complaint is more prevalent in hot and humid climates.

The most crucial measure to treat tinea cruris is to resist that compelling desire to scratch the balls. The scratching often results in complicated secondary skin infection that is difficult to treat.

The clinical resolution of the uncomplicated fungal infection is achievable by topical antifungal, and even oral medication.

Other ways to prevent such recurrence is to stop the transfer of pathogens to the groin from other body parts. This is achievable by keeping the scrotum dry after shower, using separate towels for the groin and the rest of the body.

It might also sound strange, but men troubled by Jock Itch are also advised to use the hair dryer for the groin after shower (certainly gives a different meaning to blow drying).

Affected patients are also advised to put on the socks before undergarment to minimize the possibility of fungal transfer from feet to groin.

Other causes of the itchy balls can also be caused by scrotal eczema. As both the skin complaints are similar in presentation.

The itchy scrotal at times may pose a diagnostic and therapeutic challenge to clinicians. Scrotal eczema is also known as dermatitis of the scrotal skin. This often refers to as “the itch that rashes”.

Hence the typical presentation is the itching arises before redness. In reality, sufferers can never recall whether the itch or the rashes comes first. Besides, all that scratching also results in redness of the skin.

The exact cause of the scrotal eczema is unknown and it can also affect skin around the anus, between the buttocks and on the penis.

Hence, men with scrotal eczema present with itchy balls often complain of itchy bum too.

However, unlike tinea cruris, this skin condition is non-contagious, and can be treated with topical or oral steroids.

There is no cure for scrotal eczema, and patients tend to swing between period of remission and flare-up, triggered by different causes.

The humorous American poet, Ogden Nash once said: “Happiness is having a scratch for every itch.”

When it comes to scrotal itch, indeed instant gratification is granted when that compelling desire arises to scratch, however the price to pay afterwards can be more complicated skin infections.

When Dr. G is put on the spot to deal with itchy scrotum, indeed there is a therapeutic challenge to differentiating Jock Itch from dermatitis, may warrant a trial of treatment.

When Dr. G is further put on the spot regarding scratching, I guess the response is “To scratch or not to scratch, that is the question!”

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