Having blood blister on scrotum can be quite embarrassing and disturbing for most individuals. Although harmless it may directly affect ones sexual life for some sexually transmitted disease. These blood blisters are medically called as angiokeratoma. Angiokeratomas are red to dark vascular lesions that can be diffuse or localized. The diffuse type is rare, called angiokeratoma corporis diffusum commonly seen in Fabry’s disease. The localized type is angiokeratoma circumscriptum, angiokeratoma of Mibeli, solitary angiokeratoma and angiokeratoma of scrotum or vulva. In this article we’ll discuss about angiokeratoma of the scrotum.
Angiokeratoma of scrotum are small, smooth, bright red to blue or purple colored vascular tumors that are frequently encountered in whites than darker race. They can be seen as early as late adolescence but becomes more frequent with increasing age. Initially they are small, smooth, bright red, blue to purple vascular papules but with increasing age they tend to become larger, darker and numerous and may be accompanied by scaling of the overlying skin. Although more common on scrotum they can also be seen on shaft of penis, glans, groin and lower abdomen. They can also be seen in labia of women.
Initially at early stage these lesions may be asymptomatic but as the age increase lesion tends to increase and become more symptomatic. They can be quite itchy and bleeds easily after minor trauma that can lead to pain and discomfort. Although the presentation is very clear but individual lesion can sometimes be mistaken for a nevus, melanoma, or Kaposi sarcoma
What causes such blood blisters on scrotum?
The exact cause of angiokeratoma of Fordyce is unknown; some expert regards the lesion as degenerative disorder. Some have linked it with venous hypertension, varicocele, hydrocele, inguinal hernia, benign prostatic hypertrophy, or hemorrhoid but findings are uncertain and further study needs to be done.
How is it diagnosed?
Angiokeratoma of Fordyce is usually diagnosed based on clinical examination of the lesion. When in confusion skin biopsy may be done to rule out other diseases.
Treatment of Angiokeratoma of the scrotum
These blood blisters on scrotum are totally harmless lesion and therefore asymptomatic lesion can be left untreated. However, if itching, soreness and bleeding becomes a concern or individual wants it removed for cosmetic concern they can be removed with several modalities listed below. If pain is the concern carbamazepine, pregabalin or gabapentin can be used.
Liquid nitrogen cryotherapy
1. Atherton DJ, Moss C. Angiokeratoma of the scrotum. In: Burns T, Breathnach S, Cox N, et al. Rook’s Textbook of Dermatology. Hong Kong: Blackwell; 2004:15. 89-15. 90.
2. Erkek E, Basar MM, Bagci Y, et al. Fordyce angiokeratomas as clues to local venous hypertension. Arch Dermatol. 2005;141:1325-1326.
3. Agger P, Osmundsen PE. Angiokeratoma of the scrotum (Fordyce). A case report on response to surgical treatment of varicocele. Arch Derm Venereol. 1970;50:221-224.
4. Orvieto R, Alcalay J, Leibovitz I, Nehama H. Lack of association between varicocele and angiokeratoma of the scrotum (Fordyce). Mil Med. 1994;159:523-524.