A 30 year old white male with a three year history of scrotal pruritis.
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12 5-10 mm excoriated papules with surrounding lichenification and eczematization of the anterior scrotum. The initial diagnostic impression was lichen simplex chronicus.
The patient was treated with intralesionally triamcinalone acetonide suspension (5 mg in a volume of 1cc 1% Lidocaine with Epinephrine 1:100,000). He was much improved on follow-up one month later.
Physical exam revealed a 4x12 mm indurated cord of the medial scrotum which was draining at the distal end.This was noted to be a center of the inflammatory lesions first diagnosed as lichen simplex chronicus. Serosanguinous material was expressed.
LABORATORY: A biopsy was obtained which revealed pseudostratified columnar epithelium. He responded to treatment consisting of warm compresses and Zithromax with complete resolution of the eczematization and pruritis. The cord, while still present, was greatly reduced in size. Surgical intervention was not deemed necessary.
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