INTRODUCTION: Idiopathic scrotal calcinosis (ISC) is a rare benign disorder characterized by multiple asymptomatic nodules. The nodules occur on the scrotal skin wall. The purposes of the present study were to: (1) determine whether or not there is a defect in calcium and phosphorous metabolism among patients with ISC; (2) study the effect of treatment with topical steroid and topical vitamin A on nodule recurrence.
METHODS: There were 18 patients with a mean age of 20 years (range, 18-55 years). Six of the patients reported that the nodules were asymptomatic; 12 reported symptoms of itching, heaviness in the scrotum, secondary infection in the lesions, and discharge. Evaluation included patient history, physical examination, and serum levels of calcium, phosphorous, and alkaline phosphatase. Lesions were excised. Patients in group 1 (n = 10) were treated with a long-term topical steroid for 2 weeks, followed by topical vitamin A for 6 months. Patients in group 2 (n = 8) received no topical treatment. Patients were reevaluated every 6 months for 3 years.
RESULTS: Serum levels were within the normal range for calcium (mean = 9.5 mg/dL; SD = 3.5) and phosphorous (mean = 3.2 mg/dL; SD = 0.7), but higher than normal for alkaline phosphatase (mean = 135 U/L; SD = 35). No nodule recurrence was observed in patients receiving the topical treatments. There were 4 reports of recurrence among patients receiving no topical treatments, occurring after 8, 13, 16, and 24 months.
CONCLUSION: The pathogenicity of ISC is not clear. It might be idiopathic, caused by dystrophic calcification, the result of inflammation of epidermal cysts or minor trauma, or due to degeneration and necrosis of dartos muscle. Diagnosis is solely confirmed by surgical excision and histopathologic examination. In the present study, the authors found no anomalies of calcium and phosphorous metabolism except an increase in alkaline phosphatase level. Recurrence was only seen among patients who did not receive topical treatment after surgical excision. Therefore, the authors suggest the use of local treatment of steroids and vitamin A to prevent probable recurrences. However, further studies are needed to reach a more definitive conclusion.
KEYWORDS: Idiopathic scrotal calcinosis; Calcium and phosphorous metabolism anomalies; Alkaline phosphatase
CORRESPONDENCE: Dr. Mahmood Molaei, Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran (
CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.04