Intralesional injection of triamcinolone acetonide is an effective treatment for angiokeratoma of the scrotum: a case report

In 1896, Fordyce JA firstly described numerous hemispheric dark-purple papules on the scrotum in a 60-year-old man, which was named angiokeratoma of the scrotum, also known as angiokeratoma of Fordyce [1]. Angiokeratomas most commonly arise in elderly men in the scrotum, and occasionally occur on the penis, glans, and femoral region [2]. It is characterized by multiple dark-purple (the most common), dark-red, black, or tan dome-shaped papules with a smooth surface that may be accompanied by scaling. Those papules generally distribute in parallel to superficial blood vessels or scrotal skin lines. The lesions are usually asymptomatic, but some patients might develop papule haemorrhage [3]. Clinical differentiation of this disease from diffuse angiokeratoma, malignant melanoma, or melanocytic nevus is required. A variety of treatments have been reported for angiokeratoma of the scrotum, including cryotherapy with liquid nitrogen, electrosurgery (such as electrocautery and electrofulguration), excision, lasers [3], sclerotherapy [4], and topical drug treatments (e.g. rapamycin cream and ethanolamine oleate) [5, 6]. To our knowledge, intralesional glucocorticoid injections for angiokeratoma of the scrotum have not yet been reported in literature. Herein, we present a case of angiokeratoma of the scrotum treated with intralesional injection of triamcinolone acetonide, in which a satisfactory curative effect was obtained.
A 66-year-old man presented to our clinic with a more than four-year history of numerous dark-purple hemispherical papules with diameter 2–3 mm and smooth surface in the scrotum, often accompanied by itching and spontaneously bleeding without pain. Local thickening and pigmentation were found on the skin of the scrotum (Figure 1 A). There were no similar lesions on other parts of his body. The patient did not receive medical treatment, and there was no evidence of any systemic diseases. A skin biopsy showed hyperkeratosis, subkeratotic thrombosis, hyperplasia of the spiny cell layer, and sparse perivascular inflammatory cell infiltration in the dermis. Additionally, degenerated vascular endothelial cells were visible in the superficial dermis (Figure 1 B, C). The patient was subsequently diagnosed with angiokeratomas of the scrotum based on his clinical presentation and histopathology. The patient rejected the options of painful and destructive treatments, such as cryotherapy and electrosurgery. After informed consent, the patient...


View full text...