What are your recommendations in managing pudendal neuralgia/red scrotum syndrome?

Red scrotum syndrome is very challenging to treat. The list of reported treatments is long, but I have not found one to be consistently effective. Treatment selection depends significantly on patient characteristics and preferences.

In my opinion, every patient with red scrotum syndrome should undergo patch testing as well as detailed counseling on gentle skin care practices. Imaging of the lumbar spine/pelvis can be considered for patients with relevant risk factors or atypical symptoms. The majority of my patients with this condition have psychiatric comorbidities, especially treatment-resistant depression, anxiety, OCD, or PTSD, and should ideally be under the care of a psychiatrist.

As far as treatment, topical steroids are contraindica...

I've had success with dupilumab and nemolizumab in refractory cases.

I find low dose topical steroids helpful.