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Having black spots on the scrotum is a condition that is medically termed as angiokeratoma of Fordyce. Most men are usually alarmed at the appearance of these spots on their scrotum, thinking that it may be a sign of a sexually transmitted infection – which is not true. Knowing the possible causes of these black spots and its corresponding treatment is beneficial to allay one’s fears and misconceptions.
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What are Angiokeratomas?
Angiokeratomas are characterized by dark red or purple benign, vascular spots or papules. These are comprised of damaged, dilated cutaneous capillaries and will easily bleed if scratched. These spots change into black or dark purple once blood clots have formed.
There are five known types of angiokeratomas, namely; 1) Fordyce, 2) Mibelli, 3) papular types (solitary or multiple), 4) angiokeratoma circumscriptum, and 5) angiokeratoma corporis diffusum.
Angiokeratoma of the Fordyce type is the presence of 2 – 5 mm black spots on the scrotum, but these spots may also extend to the shaft and the glans penis. These spots are actually harmless and asymptomatic. In fact, it is of little or even no clinical significance. However, angiokeratomas may become serious problems if they are caused by an underlying condition known as Anderson-Fabry Disease or sometimes referred to as Fabry’s Disease only.
The same condition occurs in females along their vulvar area and is termed as vulvar angiokeratomas. The name, “Fordyce” was derived from the person who first described the condition in 1896 – John Addison Fordyce.
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Causes and Associated Treatment
The exact cause of these black spots on the scrotum (and all other angiokeratomas) is still unknown, but there are several factors which are thought to be probable causes. The following enumerates the factors, which could have contributed to the development of this scrotal condition:
Increased Blood Vessel Pressure
Medical experts consider an increase in pressure of the blood vessels in the scrotal area as one factor that has the greatest potential to cause angiokeratoma of Fordyce. With increased pressure, small cutaneous capillaries on the scrotal area may vasodilate and even rupture; which eventually leads to these small, red, purple, or black spots. Conditions that increase the venous pressure in the scrotal area include: varicoceles, hernias, urinary system tumors and epididymal malignancies. The treatment for this is focused on treating the underlying condition that has caused the increased blood vessel pressure on the scrotum.
Enzyme-linked disorders such as: 1) Fucosidosis, a rare disorder characterized by an alpha-fucosidase enzyme deficiency and 2) GM gangliosidosis type 2, a deficiency of B and C isoenzymes of beta-galactosidase; are also pointed out as possible culprits for angiokeratoma of Fordyce, but to a lesser degree as compared to the former cause. The treatment for this cause is geared on managing the enzyme-linked disorders first. However, for such rare diseases, treatment is usually for the symptoms alone.
Although Anderson-Fabry’s Disease is highly associated with angiokeratoma corporis diffusum, the said condition may also causes black spots or papules to appear on the scrotum. This condition is a genetic disorder that is characterized by a deficiency in an enzyme that breaks down lipids. The treatment for this condition is through medications and enzyme replacement therapy.
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General Treatment Options
Generally, black spots on the scrotum and all other angiokeratomas can be treated through laser, physical therapy and radiology aimed to manage the severity of the vascular lesions.
Laser treatments for angiokeratoma of Fordyce by using pulsed-dye lasers are proven to be effective and cause only minimal side effects. Other physicians, on the other hand, use cauterization to stop the bleeding in cases wherein the papules have erupted.
Dermatologists do not specifically recommend removing these black spots on the scrotum, as these papules are actually benign, asymptomatic and medically harmless. However, if a man feels that his self-confidence and physical appearance is negatively affected by this condition, then the dermatologist may initiate any of the aforementioned options depending on the case of the patient.
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Du Vivier, Anthony & McKee, Phillip. Atlas of clinical dermatology. 3rd Edition. Elsevier Health Sciences, 2002.
Pande SY, Kharkar VD, Mahajan S. Unilateral angiokeratoma of fordyce. Indian J Dermatol Venereol Leprol 2004; 70:377-9