Dear Doctor
SEVERE jock itch (image of testicle attached to this email) – tried lotrimin (cream and spray). but only temporarily helps.
I still have severe itching which sometimes wakes me up in the middle of the night – been this way for over 2 months now and not getting better. What do I do?
Dear Patient
Your symptoms are suggestive of scabies and more specifically, nodular scabies of the scrotum.
Scabies is caused by infestation with a mite which is a human parasite that is known as Sarcoptes scabiei var hominis.
Symptoms of scabies include an itch which is usually worse at night.
There may also be a diffuse red rash and excoriation or itch marks. Small nodules or swellings are present in cases of nodular scabies.
Fine, wavy lines in which the female mites burrow into the skin to lay their eggs may also be seen on the wrists and other parts of the body.
Treatment of Scrotum Scabies
The treatment of scabies on the scrotum includes:
1. 5% Permethrin cream which should be applied from the neck down and left for 12 hours before being washed off. This application should be repeated after 1 week to ensure that any mites that may have hatched from eggs are killed.
All persons living with the affected person should be treated with the Permethrin cream even if they are not itching.
Antiparasitics like Invermectin (Stromectol) can also be taken. The dose is 200 micrograms/kg body weight. It is repeated after 2 weeks. Pregnant and lactating women should not use this medication.
2. Antihistamines are taken for 2 to 4 weeks to reduce the itch. Examples include Claritin and Benadryl. However, the itching may persist for upto 4 weeks before it resolves even after the mites have been eradicated.
3. Creams that contain steroids and antibiotics are applied to the nodules twice a day to flatten them for 2 to 4 weeks. Examples include Fusicort or Hydrocortisone.
4. All the clothes, towels and bed sheets should be washed in hot water or the hot cycle of the washing machine and drier.
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