Veterinary Dermatology 2002, 13, 63 –76

Blackwell Original Artical Science, Ltd

Review Cutaneous lesions of the canine scrotum
ROSARIO CERUNDOLO* and PAOLA MAIOLINO† *Dermatology Unit, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK, Dipartimento di Scienze Cliniche Veterinarie, Sezione di Clinica Medica, Facolta’di Medicina Veterinaria, Universita’ degli Studi di Napoli ‘Federico II’, Napoli, Italy; †Dipartimento di Patologia, Profilassi and Ispezione Degli Alimenti, Sezione di Anatomia Patologica, Facolta’ di Medicina Veterinaria Universita Degli Studi di Napoli ‘Federico II’, Napoli, Italy
(Received 15 December 2000; accepted 29 March 2001)

Abstract Scrotal lesions are uncommon and often present a diagnostic challenge. In the veterinary literature there are no texts devoted to this subject. This study reviews and illustrates canine scrotal lesions following an aetiological layout with the aim of facilitating clinical identification and diagnosis. Infectious, immune-mediated, endocrinological and neoplastic conditions are the most commonly reported causes of scrotal lesions in the dog. They may affect the scrotum only or other parts of the body as well. The clinical presentation of the lesions, the presence of primary or secondary lesions and the presence of clinical signs of systemic disease may help in obtaining a diagnosis. In some cases further investigations are necessary to reach a definitive diagnosis. Histopathology aids in understanding pathological reactions of the scrotal skin but unfortunately this is not commonly carried out and few reports in the literature include histopathology. The list of conditions given in this review is not exhaustive and other, more rare, diseases may be encountered. Keywords: dermatosis, dog, scrotum, skin.

I N T RO D U C T I O N In small animal practice scrotal skin lesions are uncommon. When they occur, understanding their cause is sometimes a challenge for the clinician. Little information specific to the scrotum is available in the veterinary literature. The aim of this review is to provide a guide that will be of value in clinical diagnosis; therapy of these conditions and diseases of the testes are not considered. Many dermatological diseases and systemic disorders may present only scrotal lesions and determining their aetiology is the best way of achieving a rational therapeutic plan. A thorough history, general physical examination to identify abnormalities elsewhere in the body, and a proper examination of the scrotum by inspection and palpation are fundamental. Appropriate complementary tests, including a biopsy of the scrotum, should be carried out. Histopathology of the scrotal skin has been reported infrequently in the literature, and thus the histopathological descriptions of many of the conditions considered in this review refer to the skin of the general body surface.

two layers: the skin and the dartos. The skin is wrinkled, pigmented, covered with a fine and variable density of hairs, and richly supplied with sweat glands. The epidermis is thick, with marked rete ridges and the dermis contains numerous large smooth muscle bundles.1 The dartos forms a common lining for both halves of the scrotum and contributes to the scrotal septum. The scrotum contains the testes, the epididymides, the distal part of the spermatic cord with its associated spermatic fascia and vaginal tunics, and the distal cremaster muscle (Fig. 1). The external pudendal artery is the main blood vessel to the scrotum and the veins parallel the arteries. Lymphatic vessels drain to the superficial inguinal lymph nodes.2 The scrotum is involved in the thermoregulation of the testes. The temperature in the scrotum is lower than that of the body core to prevent degeneration of the seminiferous tubules of the testes. Two mechanisms are involved. The first is the cooling of the arterial blood by heat exchange with the adjacent veins. The second is due to the activity of the external cremaster and tunica dartos muscles that allow the testis to be moved away from or closer to the body depending on the external temperature.3

A NATO M Y A N D H I S TO LO G Y S C RO TA L D I S E A S E S The canine scrotum is a membranous pouch divided into two cavities by a median septum and consisting of
Correspondence: Rosario Cerundolo, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania; 3900 Delancey Street, Philadelphia, PA19104, USA. © 2002 Blackwell Science Ltd

Careful clinical examination of scrotal skin lesions is important to achieve a correct diagnosis. Many diseases may show only scrotal lesions ( Table 1). Skin diseases affecting the scrotum can present a multifocal or diffuse pattern of lesions (Table 2) which may be helpful in

5 Table 2. Differential diagnosis of multifocal and diffuse scrotal lesions Multifocal lesions Blastomycoses Candidiasis Cuterebra emasculator infestation Dermatophytosis Discoid lupus erythematosus Ectoparasites Ehrlichiosis Erysipelotrix rhusiopathiae infection Erythema multiforme Fixed drug eruption Hyperandrogenism Ischaemic dermatopathy Malassezia pachydermatis dermatitis Neoplasia Pemphigus complex Pyoderma Sporotrichosis Sterile pyogranuloma Metabolic epidermal necrosis Systemic histiocytosis Systemic lupus erythematosus Toxic epidermal necrolysis Trauma Uveodermatological syndrome Vitiligo Zinc-responsive dermatosis Diffuse lesions Atopy Babesiosis Brucellosis Contact dermatitis Food hypersensitivity Frostbite Keratinization defects Incorrect castration Leishmaniosis Lethal acrodermatitis Lupoid dermatosis Protothecosis Rocky Mountain spotted fever Sunburn Thallium toxicosis © 2002 Blackwell Science Ltd. but other bacteria may be involved. In this review. 2). a brief description of each disease and its effects on the scrotum is given. 13.1.64 R. Often deep infection follows inappropriate or inadequate antibiotic treatment of a superficial infection or if underlying diseases are still present. Maiolino Figure 1. Cerundolo and P. Histopathology of superficial pyoderma shows a neutrophilic intraepidermal pustular dermatitis and/or a superficial folliculitis. Veterinary Dermatology.6 Cytology of pustules shows the presence of neutrophils and bacteria. Microorganisms may be introduced by local trauma. based on aetiological causes.4 Constant licking of the scrotum may extend bacterial infection to the underlying testicle. Table 1. Conditions that may affect only the scrotal skin Babesiosis Brucellosis Contact dermatitis Cuterebra emasculator infestation Erysipelothrix rhusiopathiae infection Fixed drug eruption Frostbite Hyperandrogenism Incorrect castration Neoplasia Protothecosis Rocky Mountain spotted fever Sunburn Trauma BAC T E R I A L I N F E C T I O N S Superficial pyoderma involves the epidermis and follicular epithelium. 63 – 76 . Full descriptions and therapeutic management of the diseases are given elsewhere. whereas deep pyoderma involves the dermis and often the subcutaneous tissues. In deep infections. Structure of the scrotum and testicle. establishing a correct differential diagnosis (Table 3).4. the lesions vary both in depth and severity. These infections are usually caused by Staphylococcus intermedius. by bruising or scratching. The primary presenting lesions are papules and pustules but later secondary lesions may occur at many sites including the scrotum (Fig.

bacterial endocarditis and septic arthritis in dogs. macules. Differential diagnosis of scrotal skin diseases according to pattern of lesions (a) Erythema. furunculosis.9 The lesions appear 1–2 weeks after intravenous inoculation or 3–5 weeks after oral inoculation of B. epididymitis. Histopathology shows a nodular to diffuse pyogranulomatous and lymphocytic dermatitis. venules and capillaries.1. canis itself invading the scrotum from within. caused by B.8 Blood culture is necessary for diagnosis. depressed areas up to 1 cm with subsequent draining of fluid from the ulcers (Fig. with several discrete.7 Erysipelothrix rhusiopathiae is an uncommon cause of bacteraemia.13 © 2002 Blackwell Science Ltd. Tieghi. canis and it is likely that the scrotal dermatitis is caused mainly by staphylococci as a consequence of persistent licking of the scrotum over painful epididymides. Varese. 13. while in deep pyoderma folliculitis. It usually causes testicular atrophy. Erythema and pustule formation in superficial staphylococcal infection. Crawford & Foil described erythematous and oedematous skin lesions with pinpoint haemorrhagic ulcers on the scrotal skin in a 9-month-old Golden Retriever. conjunctival or venereal contact with an infected dog.4. nodular to diffuse dermatitis. Figure 3. erythema and ulceration of the scrotum in Brucella canis infection (reproduced courtesy of C.Canine scrotal lesions Table 3.8 Brucellosis in dogs has been reported to be caused by Brucella canis. papules.12. prostatitis and sometimes scrotal dermatitis. Schoeb & Morton described scrotal lesions. and panniculitis are observed.10 However. Histopathology shows a vasculitis that can be systemic and is characterized by the involvement of arterioles. Oedema. raw. Italy). crusts and scales Atopy Babesiosis Blastomycoses Brucellosis Candidiasis Contact dermatitis Dermathophytosis Ectoparasites Erysipelothrix rhusiopathiae infection Erythema multiforme Fixed drug eruption (b) Crusts and ulceration Atopy Blastomycoses Brucellosis Candidiasis Cuterebra emasculator infestation Contact dermatitis Discoid lupus erythematosus (c) Hyperpigmentation Atopy Contact dermatitis (d) Oedema and sloughing Cuterebra emasculator infestation Frostbite Food hypersensitivity Frostbite Keratinization defects Leishmaniosis Lethal acrodermatitis Lupoid dermatosis Malassezia pachydermatis dermatitis Neoplasia Pemphigus complex Pyoderma Sunburn Erysipelothrix rhusiopathiae infection Erythema multiforme Fixed drug eruption Food hypersensitivity Ischaemic dermatopathy Neoplasia Pemphigus complex Food hypersensitivity Hyperandrogenism Incorrect castration Rickettiosis 65 Sterile pyogranuloma Sporotrichosis Metabolic epidermal necrosis Systemic lupus erythematosus Systemic histiocitosis Thallium toxicosis Toxic epidermal necrolysis Trauma Zinc-responsive dermatosis Protothecosis Sporotrichosis Metabolic epidermal necrosis Systemic lupus erythematosus Sterile pyogranuloma Systemic histiocitosis Toxic epidermal necrolysis Pyoderma Vascular hamartoma Testicular torsion Trauma Figure 2. 63–76 .11 Serological investigations and bacteriological culture are diagnostic. 3). which is usually transmitted through oronasal. Veterinary Dermatology.

nodules and ulcers. systemic diseases.14 Detection of the morula inside a monocyte in a blood smear and serological investigation are diagnostic. Sporothrix schenckii. which may cause superficial or deep infection.1. The superficial infections are often generalized.5 Candida spp. The clinical signs are circular patches of alopecia with variable scaling.16 Serological investigations are diagnostic.1. steroid and immuno© 2002 Blackwell Science Ltd. Clinical signs include pruritus.1 Malassezia pachydermatis dermatitis is caused by yeasts commonly found on normal skin but predisposing factors. in immunosuppressed dogs.7.21 Protothecosis is a systemic mycosis caused by Prototheca wickerhamii a ubiquitous.4. dermatitis is a rare infection most commonly caused by the yeast C. which are transmitted by contact with infected hair or scales derived from other animals or their environment.4 Diagnosis is based on direct microscopical examination and cultures of plucked hairs and scrapings. 13. scales and crusts. canis infection some dogs may develop scrotal oedema.66 R. Histopathology shows variable acanthosis. zoonotic disease caused by Rickettsia rickettsii. Figure 5. debilitation. Rocky Mountain spotted fever (RMSF) is a tickborne. and a serological test is more useful.. Cytological examination of material aspirated from the lesions and fungal culture are not always diagnostic.19 Cytology shows the presence of numerous monopolar budding yeasts. excessive moisture. Clinical signs are more often localized to the skin including the scrotum.18 Cytology shows the presence of numerous ovoid yeasts. perivascular to interstitial dermatitis with diffuse lymphocytic exocytosis and epidermal spongiosis. The cutaneous lesions are papules. Cerundolo and P. or diffuse erythema with fine follicular papules. albicans. erythema and the presence of greasiness. Primary scrotal involvement has been reported in a Collie with scrotal swelling. axilla. ulcerated. The signs are highly variable and may be localized or generalized with associated bacterial infection. Spain). Necrosis and sloughing of the lower part of the scrotum in Rickettsia rickettsii infection. crusty and pruritic. 63 – 76 suppressive agents. Histopathology shows a massive parakeratotic hyperkeratosis with a severe neutrophilic intraepidermal pustular dermatitis. The scrotal lesions are moist.4 They often have a stiff gait and are reluctant to walk. saprophytic achlorophyllous alga that can cause disseminated infection or skin lesions via wound contamination. Ginel. Cordoba. ortho. RICKETTSIAL INFECTIONS Ehrlichiosis. is characterized by a variety of clinical syndromes. and neutrophilic folliculitis and furunculosis in more advanced lesions. The cutaneous form is usually a manifestation of the disseminated disease and presents as single or multiple papules. Veterinary Dermatology. Necrosis and sloughing of the oedematous scrotum may follow (Fig. oedema and ulceration.17. scales and crusts. Histopathology reveals a hyperplastic.8 FUNGAL INFECTIONS Dermatophytosis is caused by fungi of the genera Microsporum and Trichophyton.1. superficial. Dermatophytes may be seen in or around protruding hairs or occasionally free within epidermal keratin. as the yeasts are rarely found in dogs.7 Blastomycosis is a chronic granulomatous suppurative systemic mycosis caused by inhalation of the spores of Blastomyces dermatitidis. 5) and secondary generalized lesions. Some dogs may present with scrotal erythema. Histopathology in ehrlichiosis and RMSF shows a vasculitis. Erythema and ulceration in protothecosis (reproduced courtesy of P. It is usually secondary to trauma. including breed. Maiolino Figure 4.and parakeratotic hyperkeratosis which extend into the follicular infundibula. subcutaneous tissues and lymphatics. may cause increased multiplication that leads to disease.20 Lesions are multiple firm nodules and ulcerated plaques that may develop draining tracts. In the subclinical and chronic phases of E.22 . eroded.5. which exists as a saprophyte in soil and organic debris. to prolonged antibacterial. nodules or draining tracts exuding a seropurulent material. inguinal area and the scrotum. Histopathology shows nodular to diffuse pyogranulomatous dermatitis and panniculitis.15. 4). use of antibiotics and. Skin lesions are frequently observed in intertriginous areas such as the ventral neck.1 Sporotrichosis is caused by the ubiquitous fungus. a tick-borne disease caused by Ehrlichia spp. ulceration (Fig.

Diffuse exfoliative dermatitis in leishmaniosis. are flies that may rarely affect the dog26 but no recent reports of scrotal infestation are available. and Demodex spp.7.7 © 2002 Blackwell Science Ltd. thrombocytopenia may produce haemorrhagic macules on the scrotum.4 Thickening of the scrotal skin may interfere with the scrotum’s ability to control testicular temperature and might contribute to thermal testicular degeneration.3 A restriction diet. there are slightly erythematous macules. diffuse superficial dermal oedema and vasodilatation.24. Veterinary Dermatology. which parasitize red blood cells. Initially.M E D I AT E D D I S E A S E S Atopy is a hypersensitivity disease in which the patient becomes sensitized to environmental antigens. are usually associated with pruritus and may be localized on the face. inflammation and dislocation of the testes. based on a source of protein and carbohydrate not fed previously. pustules and comedones with hyperpigmentation commonly affect the face. Areas of the body in contact with the ground are more commonly affected. Subsequently. The organism is present in macrophages and the infection causes a chronic systemic disease. In demodicosis papules. Skin lesions. The fly deposits its eggs by piercing .Canine scrotal lesions 67 Figure 6. the most consistent lesion is a superficial perivascular dermatitis with the presence of mononuclear cells.28 Parasites such as Sarcoptes spp. 6) and ulcers are commonly seen.1. Numerous amastigotes are present within the macrophages and some are found free in the tissue. Histopathology shows a neutrophilic vasculitis. including the scrotum. involving also the scrotum.27.7 Food sensitivity is an abnormal clinical response to an ingested food and can be manifested by cutaneous and/or gastrointestinal signs.1.22 the scrotum and the developing larva projects through the puncture while the greater portion is buried and surrounded by a zone of inflammatory tissue. Cutaneous lesions with excessive scaling (Fig. Histopathology is not particularly useful in the diagnosis of atopy. It apparently gives the animal no discomfort unless the parasite causes an abscess with following necrosis of the scrotum. Histopathology shows orthokeratotic hyperkeratosis and a superficial and deep perivascular dermatitis characterized by histiocytes and small numbers of lymphocytes. 13. may also infest the scrotal skin. Skin lesions are usually localized on the face. limbs. acute or chronic. mixed perivascular inflammatory infiltrate and dermal oedema. Diagnosis is based on Willemse’s criteria and exclusion of other hypersensitivity disorders. The clinical signs vary and are peracute. Cytological examination of material aspirated from the lesions is diagnostic and culture can confirm the diagnosis. However. usually associated with pruritus.25 Cytological examination of blood smears and serological investigations are diagnostic. The follicular epithelium is usually hyperplastic and may be hyperkeratotic. The presence of pruritus with erythema. Cuterebra emasculator may affect the scrotum of wild animals as well as dogs in some regions of the United States. Secondary bacterial and yeast infections usually contribute to the severity of the skin lesions. hyperpigmentation. with IgE or IgGd production.1 Babesiosis is a tick-borne disease caused by Babesia spp.29 Intradermal and serological tests may help to understand which antigen may be involved in this condition .6. papules and crusts also affecting other areas of the body should lead to a suspicion of sarcoptic mange. 63–76 P RO TO Z OA L I N F E C T I O N S Leishmaniosis is caused by protozoa of the genus Leishmania that are transmitted by bloodsucking insects of the genus Phlebotomus or Lutzomia. Skin scrapings and hair pluckings are usually diagnostic.. limbs and ventrum. The age of onset varies from 6 months to 7 years and the clinical signs may be seasonal or nonseasonal depending on the allergens involved.4 I M M U N E . leading to secondary bacterial and yeast infections. primary or secondary.23 Cytological examination of aspirates from the lymph nodes or the bone marrow and serological investigations are diagnostic.25 PA R A S I T I C I N F E S TAT I O N S Cuterebra spp. salivary staining and signs of self-trauma. limbs and inguinal area. is essential to diagnose this condition. Histopathology is not specific and shows a superficial and deep perivascular dermatitis. Histopathology in blastomycosis and protothecosis shows a superficial and deep pyogranulomatous dermatitis with abundant microorganisms in most cases. alopecia. axillae and ventrum. axillae. and acanthosis.24. lichenification and seborrhoea may develop. plasma cells and neutrophils. Note the large scales. Larvae of Pelodera strongyloides or hookworms may also infest the scrotal skin causing erythema. In severely affected dogs. The scrotum becomes oedematous and a round firm mass may be palpated.

8). Multiple erythematous brown crusted lesions in pemphigus foliaceus. which may show erosive and ulcerative lesions. Histopathology shows a cell-poor subepidermal vesicular dermatitis with full thickness coagulative epidermal necrosis that may extend into the external root sheath of the hair follicle. London. the skin and the scrotum.1. or generalized.33 Pemphigus vulgaris is a rare disease characterized by an acute onset in association with systemic signs. remain anchored to the basement membrane zone like a ‘row of tombstones’. ulcerative lesions affecting the oral cavity. Cerundolo and P. urticarial plaques and vesicles. a process known as satellitosis.34 Histopathology shows a heavy © 2002 Blackwell Science Ltd.40 Various degree of focal or multifocal Figure 7. papules.7 Ischaemic dermatopathy has been reported following rabies vaccination. pinnae. tumours and other systemic disorders. UK).33 Cutaneous lupus erythematosus is a disease characterized by depigmentation and ulceration with crusts affecting the planum nasale and lips. footpads and less frequently the scrotum. Dermal inflammation is minimal or absent. and the formation of vesicles or bullae. sometimes involving the scrotum and leading to ulceration. Certain drugs (sulphonamides. Histopathology shows a severe reaction in which numerous apoptotic keratinocytes are present at all levels of the epidermis and within the adnexal epithelia.1 Erythema multiforme is a condition that has been associated with infections. macules and wheals following 20 days of levamisole for the treatment of dirofilariasis.7. as well as in humans.39 described scrotal lesions in a dog with generalized erythema. Curtis. and may closely surround the apoptotic keratinocytes. Generalized lesions sometimes occur in pemphigus foliaceus.4 In particular. proteinuria and anaemia. and marked pigmentary incontinence may also be present. neoplasia and connective tissue diseases.35 Histopathology shows a mild to moderately intense lymphocytic interface dermatitis with hydropic degeneration and necrosis of the basal cell layer of the epidermis with formation of colloid bodies.6. around hair follicles and adnexal glands. the mucocutaneous junctions.32 are characterized by gradual onset of a vesiculobullous or pustular dermatitis. The disease presents as vesiculobullous. The diagnosis in dogs. drugs. ears.1. Van Hees et al. They usually affect the bridge of the nose.1.36–38 Histopathological findings are variable but may include an interface dermatitis composed of lymphocytes and plasma cells. The acute skin lesions are variable and include erythematous macules. Fever.1. Separation of the necrotic epidermis occurs at the dermoepidermal junction and leads to subepidermal vesiculation. Skin findings are characterized by vesiculobullous lesions with necrosis and ulceration. The basal cells of the epidermis. with superficial and deep perivascular dermatitis.33 Systemic lupus erythematosus is a rare disorder with a multifactorial aetiology. fever. Hydropic degeneration of the basal cells and apoptosis of individual keratinocytes during the acute and subacute phase. erosive. 5-fluorocytosine and aurothioglucose have been reported to cause scrotal pruritus with subsequent self-trauma and well-demarcated scrotal ulceration. anorexia and lethargy are common systemic signs.35 Granulomatous vasculitis has also been reported in the scrotal skin of one dog. penicillins and cephalosporins) are more frequently reported to produce hypersensitivity-like reactions. diethylcarbamazine.7 Toxic epidermal necrolysis has been also associated with drug administration. Lymphocytes infiltrate into the affected epidermis. The clinical signs include polyarthritis.68 R. however. Histopathology shows a suprabasilar acantholysis with resultant clefting. 13. Cytological examination of the pustule contents shows neutrophils and acanthocytes. Figure 8. An important finding is hair follicle involvement.4 Cutaneous drug reactions can mimic virtually any dermatosis.7. distal limbs and the scrotum (Fig. Erythema and erosion in cutaneous lupus erythematosus (reproduced courtesy of C.33 Fixed drug eruption is a rare reaction potentially caused by any drug administered topically or systemically. should meet four of the criteria established by the American Rheumatism Association. Pemphigus foliaceus30 (Fig. The process may extend into the hair follicle epithelium. Veterinary Dermatology. and less commonly the periocular area. toxins. Maiolino band of lymphocytes and plasma cells along the dermoepidermal junction. 7) and pemphigus erythematosus31.1. the lesions resolve when the drug is withdrawn and return when the drug is reinstated. Histopathology shows a subcorneal or intragranular vesiculopustular dermatitis with acantholytic keratinocytes. Skin lesions may be extremely diverse and multifocal. 63 – 76 . although separated from each other by loss of their intercellular bridges.

foot pads. crusts and ulceration in superficial necrolytic dermatitis (reproduced courtesy of E. Repeated or continuous challenge is necessary for sensitization to occur and for the signs to develop. Histopathology shows a perivascular dermatitis with diffuse parakeratotic hyperkeratosis and a band of hydropic.1. Affected animals develop. macules and papules with serous exudation followed by formation of crusts.Canine scrotal lesions alopecia. parakeratotic hyperkeratosis and folliculitis. London.50 Little et al. The primary lesions are patches of erythema. Breed predisposition and the clinical findings are suggestive of this condition.4. is evident. Ferguson. particularly in more advanced lesions. the skin overlying the bony prominences and the scrotum. The pathogenesis of this disease is undetermined.45 An enlarged testis or high level of blood testosterone is diagnostic.44 The clinical signs of the two syndromes are similar and differentiation between them is not always easy.49 described a case in which scrotal lesions developed following hepatic injury owing to the ingestion of mouldy biscuits containing a mycotoxin.48 Erythema and scaling followed by erosion or ulceration and crusting with sticky exudate are observed (Fig.and intercellular oedema contribute to epidermal pallor. limbs and scrotum with cracking of the footpads and paronychia. early in life. crusted and ulcerated skin lesions on the face.40 Histopathology of alopecic areas shows follicular atrophy. It may be caused by many strong irritants (such as acids and alkalis) or other substances. A detailed history and avoidance of contact with the suspected agents will help to identify the cause of the condition.4 Figure 9. Numerous substances have been incriminated including cement.7 H E R E D I TA RY D I S E A S E S Lethal acrodermatitis of the Bull Terrier is a rare. erosions. An enlarged or retained testicle is suggestive of this condition. Erythema. Lesions are observed not only on the scrotum but at all potential contact sites especially if the animal lies on or walks over the responsible substance. tail. A superficial perivascular dermatitis. Scales © 2002 Blackwell Science Ltd. such as soap. lymphocitic perivascular inflammation and vasculitis are present in deep dermis and panniculus. Sertoli’s cell tumour is the most common of the testicular tumours. 63–76 ENDOCRINE DISEASES Hyperandrogenism. The presence of a high glucagon concentration due to a glucagonoma may be the cause of the decrease in the plasma amino acid levels which can occur prior to the appearance of skin lesions.51 Lupoid dermatosis of the German Short-Haired Pointer is presumed to be a hereditary disease. Both intra.43 Contact hypersensitivity is a type IV reaction and only a few dogs in an exposed population may develop clinical signs of the disease. ulcers. including selenium and povidone iodine. pale-staining keratinocytes in the upper half of a usually acanthotic stratum spinosum. In . Sometimes the lesions may be seasonal if plant allergens are involved. crusts and hyperpigmentation may affect the face pinnae. Symmetrical alopecia. the macular melanosis fades slowly over a 6-month period. idiopathic hyperandrogenism. If multiple dogs in a kennel are affected. Metabolic epidermal necrosis (superficial necrolytic dermatitis.40 69 C O N TAC T D E R M AT I T I S This disease is conventionally divided into irritant and hypersensitivity reactions although both conditions are likely to be involved to some extent in every instance. In both cases. it may not be possible to distinguish between irritant contact dermatitis and contact hypersensitivity. 9). In contact hypersensitivity. UK).4. detergents and medicated shampoos require repeated contact to cause injury.1. excoriation and hyperpigmentation. spongiotic in the acute phase and hyperplastic in the chronic phase. pendulus prepuce and inguinal and scrotal hyperpigmentation are common clinical findings. Veterinary Dermatology.47 Scrotal lesions may sometimes be the first sign noted. It is associated with perianal gland and tail gland hyperplasia and macular pigmentation of the scrotal skin. As these cells degenerate. synthetic textiles. Intense pruritus may promote severe self-trauma. a secondary bacterial infection may follow. Histologically. Histopathology shows diffuse.41 Irritant contact dermatitis is a reaction due specifically to the irritating effects of a substance with no immune basis. patch tests may be used. The lesions may be common in dogs kennelled on concrete floors. 13. hepatocutaneous syndrome) has been associated with hepatic or pancreatic disease in old dogs. Other substances. is a rare disease which may be caused by an interstitial cell tumour of the testis. Blood oestrogen may be elevated.42 that injure the scrotal skin following a single exposure. gynecomastia. clefts and vesicles may form in the outer stratum spinosum.46. primary irritant contact dermatitis is much more likely than contact hypersensitivity.49. familial disease in which a defect in zinc metabolism at the cellular level has been suspected. soil cleaning products and topical drugs.

5 Frostbite affecting the ears. whereas chronic lesions show a superficial perivascular dermatitis with prominent orthokeratotic or parakeratotic hyperkeratosis of epidermis and hair follicles. Histopathology shows an inflammatory interface dermatitis. crusting and scaling around the mouth.55 Severe lesions such as urine scalding may occur following burns or trauma which lead the dog to a sedentary position or to incontinence. Clinical signs depend on the severity of the injury. . Marked spongiosis and/or intracellular oedema are evident at the surface and in the external root sheath epithelium. A stiff gait may be noted and the dog prefers to sit.54 The cutaneous changes are somewhat dependent on haircoat type and breed. The scrotal skin becomes erythematous. Veterinary Dermatology.4 Sebaceous adenitis is an idiopathic. Cerundolo and P. ears. although old dogs may also be affected. 10) and the scrotum is sensitive to palpation. scales) are usually generalized involving also the scrotal skin. Trauma to the parietal vaginal tunic of the testis can result in orchitis with subsequent oedema and sloughing of the ventral scrotal skin. are initially undetected because of the paucity of clinical signs.54 Figure 10. causing further inflammation and possible infection. V.1 N U T R I T I O NA L D I S E A S E S Zinc-responsive dermatosis has been reported most frequently in Siberian Huskies and Alaskan Malamutes in which a poor or defective absorption of zinc has been suspected. and then become generalized. probably hereditary.56 Thallium toxicosis is a cumulative. The cutaneous lesions (seborrhoea. chin. Frequently.70 R. The sebaceous glands are progressively destroyed by a granulomatous reaction and are completely absent in the final stages of the disease. personal communication). orthokeratotic hyperkeratosis and acanthosis with hyperpigmentation of the epithelium. Mason.52 Keratinization defects can be congenital (primary seborrhoea.53 Breed predisposition and clinical findings may be indicative of this condition. the skin becomes necrotic and sloughs. Pyrexia is present and the hocks and the scrotum are markedly pruritic. necrosis and subsequent infection of the wound (K. Crusts and eventually ulceration may be seen as the lesion progress. sebaceous adenitis). sparsely haired skin of the flank. similar findings are present in some follicles. E N V I RO N M E N TA L D I S E A S E S Traumatic lesions are uncommon despite the exposed location of the scrotum. Early lesions show granulomatous to pyogranulomatous dermatitis. Minor abrasions and lacerations such as those which occur in hunting dogs owing to thick vegetation. They show erythema followed by alopecia. but in severe cases the skin may become pale owing to vasoconstriction and subsequent ischaemia. Thallium may produce systemic toxicity and in the chronic form there is a generalized alopecia with erythema and necrosis of the skin. In severe cases. Mason. Maiolino and crusts are initially localized on the face and ears. ventral abdomen and the scrotum (K. general cell poisoning normally caused by a rodenticide which was used frequently in the past. disease commonly seen in Standard Poodles but reported also in other breeds. ichthyosis) or acquired (vitamin A-responsive dermatosis. Hair follicles are mostly in catagen or telogen. Incorrect castration. may lead to ischaemia. The affected animal frequently licks at scrotal wounds. 63 – 76 Predisposed areas are the unpigmented. Histopathological findings are variable depending on the severity of the lesions. Oedema and erosion with diffuse erythema and a large bruise of the inguinal area following a road traffic accident. © 2002 Blackwell Science Ltd. carried out illegally by members of the public by applying a rubber band to the base of the scrotum.58 Histopathology shows massive and diffuse parakeratotic hyperkeratosis that extends into follicular infundibula. Inflammation with or without infection may be seen (Fig. Sunburn is caused by chronic exposure to strong sunlight and may occur commonly during the summer in dogs such as Dalmatians and white Bull Terriers. tail tip and scrotum. less frequently.1.4 Clinical signs may be suggestive of this condition but skin biopsy helps to confirm the diagnosis.52.7. the scrotum and the prepuce. personal communication). Palpation of the area may reveal an uneven surface owing to the thickening of the skin. clinical signs and the presence of follicular casts are indicative of this condition. 13.4 Breed predisposition. The superficial dermis shows oedema. eyes and.57 thickened and slightly oedematous with subsequent alopecia and scale formation. V. In mild cases only hyperaemia and oedema are observed.59 The onset of skin lesions frequently occurs during puberty. Continued exposure to sunlight may predispose to squamous cell carcinoma. In short-haired breeds the lesions are circular with alopecia and scaling. may occur during cold weather particularly in those breeds in which the scrotal skin is sparsely covered by hair. the caudal aspect of the scrotum is affected and in the early stages there is erythema and scaling. In longhaired breeds alopecia may be patchy but is usually more generalized and the degree of scaling is very pronounced.

Uveodermatological syndrome ( Vogt-Koyanagi-Haradalike syndrome) is a rare.5 Sites of dihidroxyphenylalanine oxidase (Dopa-oxidase) activity are absent. pinna. possibly autoimmune. spontaneous repigmentation may be observed without any treatment. hyperpigmented macules must be differentiated from the normal patchy appearance of the scrotum in some dogs. MISCELLANEOUS DISORDERS Sterile pyogranuloma is a disease in which the aetiology and pathogenesis are unknown. it may also affect other breeds causing progressive cutaneous depigmentation including of the scrotum (Fig. paws and scrotum. as in uveodermatological syndrome.60.4. Patchy depigmentation of the lower part of the scrotum and prepuce in idiopathic vitiligo-like depigmentation. Erythema and ulcerated nodules in squamous cell carcinoma (reproduced courtesy of F.Canine scrotal lesions Histopathology shows a superficial perivascular dermatitis with diffuse parakeratotic hyperkeratosis.62 Other clinical signs.5 71 P I G M E N TA RY D I S O R D E R S Hypopigmentation is a decreased amount of melanin in the epidermis and is associated with congenital or acquired defects in melanization such as occurs following trauma or chemical injuries. 11).63 Histopathology shows normal to moderately acanthotic epidermis with large perifollicular granulomas or pyogranulomas.5 Vitiligo has been described in Belgian Tervurens in which a familial predisposition was reported.1.1. plaques and nodules that may ulcerate on the head. Albanese. However. They track hair follicles but do not invade them. buffy coat examination and diagnostic imaging investigations are necessary in some cases to rule out tumour metastases. extending throughout the thickness of the skin with some invasion of the dartos. Italy) © 2002 Blackwell Science Ltd.64. Epithelial tumours such as squamous cell carcinoma (SCC) (Fig. Hyperpigmentation is an excessive amount of melanin deposited within the epidermis and may be either macular as in hyperandrogenism owing to testicular neoplasia (see above) and in vascular hamartoma (see later). sometimes atypical. Histopathology shows a lymphohistiocytic interface dermatitis with parakeratotic hyperkeratosis.4 S C RO TA L N E O P L A S M S Many cutaneous neoplasms may affect the scrotum either as primary localization or following metastasis. Histopathology of depigmented skin reveals a mild interface accumulation of lymphocytes and macrophages in early lesions and absence of melanocytes and melanin-containing keratinocytes.61 Clinical findings are suggestive of this condition.66–70 Histopathology of SCC shows a neoplastic proliferation composed of irregular cords and clumps of epidermal cells infiltrating the underlying tissues. acanthosis and dyskeratosis. but an immune-mediated pathogenesis is suspected. Figure 12. the cutaneous depigmentation is not only an aesthetic problem but may also predispose to sunburn. mesenchymal or melanocytic origin. Veterinary Dermatology. Cutaneous neoplasms are of epithelial. Naples. Large numbers of ‘horn pearls’ and numerous mitotic figures. 13. acanthosis and marked pigmentary incontinence.64 Histopathology of SGA shows neoplastic tissue. Occasionally. In vitiligo. or diffuse as in chronic inflammatory diseases (hypersensitivity disorders) and hormonal dermatoses (Sertoli’s cell tumour). which are elongated and vertically orientated. bone marrow biopsy. are absent in vitiligo. are frequently found.4 There are firm.64–66 Fineneedle aspiration biopsies and impression smears are useful techniques to reach the diagnosis. SCC may be more common in dogs with unpigmented scrotal skin. disease characterized by a concurrent granulomatous uveitis and progressive depigmentation with dermatitis of the head and scrotum. nonpruritic papules. composed of an irregular proliferation of epithelial cells usually arranged in thin Figure 11. however. 63–76 . It may be also caused by an immune-mediated destruction of the melanocytes. 12) and sweat gland adenocarcinoma (SGA) are usually solitary and circumscribed nodules. Careful examination and fine-needle aspiration of superficial lymph nodes.

mucocutaneous ulceration and depigmentation.5 Mesenchymal tumours characterized by the histological presence of round cells also occur.66 Histopathology shows immature fibroblasts which are usually fusiform. 63 – 76 Figure 13. and have a variable amount of collagenous fibre. The tumours are usually solitary. and haemangiosarcoma. It is usually solitary.69 The overlying epidermis becomes thickened and is frequently ulcerated because of chronic licking.4.4 The scrotum may be affected in the generalized form characterized by pruritus. plaques and nodules that may ulcerate and have a crateriform appearance are commonly seen (Fig. are common and undifferentiated tumours may have multinucleate giant cells and cells with bizarre shapes. Mitotic figures. indented or lobulated nuclei surrounded by a fine fibrovascular stroma and infiltrating the dermis and subcutis. occur in adult and old dogs. called Pautrier’s microabscesses. The cytoplasm is pale staining and abundant. the neoplastic tissue is composed of immature elongate endothelial cells with round or ovoid nuclei which are very hyperchromatic. and displacing the collagen fibres and adnexae. Veterinary Dermatology. swollen and bruised following vasoactive amine release from the mast cells. poorly delineated oedematous swelling of the skin.1. Histopathology shows blood-filled vascular spaces lined by single layer of well-differentiated flattened endothelial cells. round. Similar infiltration of neoplastic lymphocytes is also observed within the superficial dermis and within the epithelia of hair follicles and apocrine sweat glands. (Fig. either single or in clusters. round. of variable size. Young dogs of pure breed are frequently affected. erythematous.66.75 Histopathology of the former tumour shows uniform sheets of pleomorphic histiocytic cells infiltrating the dermis and subcutis. Cerundolo and P. alopecic.72 R. mitotic figures. solitary or multiple cutaneous plaques or nodules.73 It begins as single or multiple. The adnexal involvement may precede epidermal involvement.4.5 Histopathology of the latter shows a neoplastic proliferation composed of fibroblasts and histiocytes containing abundant and vacuolated cytoplasm. circumscribed.72 In haemagiosarcoma.5 Histiocytic tumours such as histiocytoma and benign fibrous histiocytoma are benign tumours originating from Langerhans’ cells. and myxoma.71 The latter appears as a plaque or a solitary nodule. Lymphocytes and plasma cells are commonly present.5 Mesenchymal tumours characterized by the histological presence of spindle cells (from blood vessels endothelium) such as haemangioma. hyperpigmented macules consisting microscopically of collapsed capillaries that progress to firm plaques as the capillaries become dilated with blood.71.5.74 Histopathology shows sheets or large nests of neoplastic cells with oval.1.5. and the form with cutaneous plaques and/or nodules © 2002 Blackwell Science Ltd.65. The lesions appear as solitary. a benign neoplasm. Four different clinical syndromes may be seen: exfoliative erythroderma. sometimes ulcerating.78 The scrotum may be hot.64 Mesenchymal tumours characterized by the histological presence of spindle cells (fibroblast origin) such as fibrosarcoma. Usually the tumour occurs as a well-circumscribed solitary cutaneous nodule (Fig. poorly demarcated and nonencapsulated. In the former. arise from fibroblasts and occur in adult dogs. Histopathology shows epidermal infiltrates of atypical lymphocytes. elevated. especially at the periphery of the masses.4. are common.1. a rare benign one. 13).5 Cutaneous and systemic histiocytosis is an uncommon disease caused by a histiocytic proliferation of Langerhans’ cells. .71. Histopathology of the skin shows a nodular to diffuse infiltration of cytologically normal histiocytes in the superficial and deep dermis and panniculus adiposus. smooth. sometimes atypical. irregular and nodular in shape. domeshaped nodules that may ulcerate.66.5. and there are repeated episodes of profuse bleeding. but they may be ovoid or stellate in shape.70 A scrotal myxoma arising from subcutaneous fibroblasts has been reported. raised. the overlying epidermis is usually alopecic and secondary ulceration may occur.4. Histiocytic infiltration of the scrotal skin is usually more diffuse and severe and extends beyond the panniculus to involve the common vaginal tunica.1. 13.77. Maiolino irregular cords with frequent formation of glandular spaces resembling sweat glands. and infiltrative and ulcerative oral mucosal disease.5 Vascular hamartoma is believed to be a progressive vascular malformation rather than a true neoplasm.4. Diffuse erythema and ulceration in a case of nonepitheliotropic lymphoma.76 Mast cell tumour is the most common scrotal neoplasm in the dog. sometimes atypical. Papules.69. a malignant one.74 Epitheliotropic lymphoma is a tumour of T-cell origin and usually affects old dogs. 15) but it may also present as a single or diffuse. erythema and scaling.70. 14). pink to red and dermal in localization.69. firm to soft. Plasmacytoma originates from plasma cells and is found principally in adult dogs.5. Histopathology shows acanthosis and increased melanin pigmentation with dermal fibrosis and a cavernous dilatation of blood vessels.69 Histopathology shows considerable variation of the tumour and a classification and grading system has been proposed based on the degree of cellular differentiation. rapidly growing. It has been described in closely related Bernese Mountain Dogs but also other breeds may be affected.66. In fibrosarcoma. a malignant tumour. Mitotic figures are numerous. The neoplastic cells are round to ovoid in shape and have large nuclei. Adult and old dogs of breeds with pigmented scrotal skin are reported to have a higher incidence. Lymphocytes vary in size and may have a hyperchromatic and convoluted nucleus.

or regressive state. rapidly growing masses with a smooth appearance that may be amelanotic or dark brown to grey or black in colour. Diseases of the testes. 7. H. P..D.71 The tumour is usually solitary and often malignant. Circular crusts and scales with erythema in a case of systemic histiocytosis. clinical and clinicopathological changes of experimental © 2002 Blackwell Science Ltd. Saunders. George.S. 11: 400–15. C. C. 4th edn.O. 12. with thin and shiny skin or ulcerative lesions. 13. Carmichael. 6. Canine ehrlichiosis. ed.E. G.66..W.. et al. Muller and Kirk’s Small Animal Dermatology. W. Miller’s Anatomy of the Dog. Crawford... 1994. ed.. K. Scott. P. R. D.. St.P. The nuclei are large. Canine brucellosis. 40: 1589–95.E. 5. 2.1. 6th edn.J. San Diego: Academic Press.W. N. 4. The tumours metastasize especially in immunosuppressed animals.W. et al.F...79. 1993: 531–738.70 A C K N OW L E D G E M E N T S The authors would like to thank Prof.V. Suchmann. David Lloyd who provided helpful suggestions and critical review of the manuscript and Dr Letizia Davino who drew Fig. Saunders. Veterinary Dermatopathology.. C.C. G. 14. eds.. Edqvist. 156: 1726–34. Ulcerated nodules and papules in a dog with a mast cell tumour.J. C. E. Morton.. Stabenfeld. pathogenesis and immune response.69 Histopathology shows intraepidermal and/or dermal tumour cells with considerable variation in appearance (spindle. Saunders. Ithaca..E. Figure 14. Barton.. Scott. Mitotic figures are usually rare in benign melanomas and extremely numerous in malignant melanomas. Miller. 3rd edn. 1990: 573–84. Foci of tumour necrosis and collagenolysis are found. Scrotal and testicular changes in canine brucellosis: a case report. Palmer. which may appear swollen and reddened. Greene. R. Infectious Diseases of the Dog and Cat. Kenney.E.. D. London: Wolfe. W.. D.5 Transmissible venereal tumour is generally found in sexually intact males affecting the external surface of the penis and the scrotum.E. In: Jubb.67 The gross appearance ranges from black macules to large. Dukes’ Physiology of Domestic Animals. In: Greene. The urogenital system. Forrester..C.H. Compendium on Continuing Education for the Practicing Veterinarian 1989. Veterinary Dermatology. 1993: 665–77. T.P. The incidence is highest in middleaged dogs. C. 1990: 404–14. 8. A Macroscopic and Microscopic Evaluation of Canine and Feline Skin Disease.A. D. Dermatophatology and Skin Tumours. H.V.. Griffin. L. round and hyperchromatic with distinctly marginal chromatin and large central nucleoli.L. Carmichael.A. Yager.69.E. J. eds. ed. Color Atlas and Text of Surgical Pathology of the Dog and Cat. 3.H. Infectious Diseases of the Dog and Cat..1.4 Melanoma is a neoplasm composed of melaninproducing cells..C. In: Greene. R. RE F E RE N C E S 1.66. Journal of the American Veterinary Medical Association 1970. Keenan. cords or small clusters of more or less recognizable mast cells are seen associated with numerous eosinophils.Canine scrotal lesions 73 by pigmentary content and arrangement in clusters or nests rather than by cellular characteristics.C. 13. 10. MO: Mosby Year Book.B.E. S. B. L. Evans.L.1. M. 11. Canine brucellosis. Troy.. ovoid or polyhedral cells with indistinct boundaries and poorly stained or clear cytoplasm. Pyogranulomatous dermatitis associated with Brucella canis infection in a dog. Pathology of Domestic Animals . T. J. New York: Churchill Livingstone. L. Christensen.. Reece. Semen examination in dogs with canine brucellosis. Philadelphia: W. Kennedy.E. 63–76 Figure 15. Yager.B. 2000. 15. The type and number of infiltrating lymphocytes depend on whether the tumour is in a progressive.B. Dawkins.G. Walder. 1992. steady. The clinical disease. epithelioid and round cells) that are often recognized .V. The cells are in compact masses or sheets and sometimes grow in rows.. Buhles. Handbook of Small Animal Practice. G. Philadelphia: W. 172: 598–600. M. Schoeb. 1988: 655–60. Journal of the American Veterinary Medical Association 1982. Wilcock. cords or loose in a delicate stroma. 1993: 504–58. NY: Comstock Publishing. Studies on the pathogenesis of Rickettsia rickettsii in the dog.R. Huxsoll. ed. 181: 1432–3.M. L. Gross. The skin and appendages.J. W.. 1. Machotka.B.A.E.. Ihrke. Philadelphia: W. S. In: Morgan. Journal of the American Veterinary Medical Association 1978. Saunders. 9. In: Swenson. Sheets. C. K. Vasculitis: clinical syndromes in small animals. Louis. B.80 Histopathology shows round.. Foil. American Journal of Veterinary Research 1979. In: Evans.L. 1. Philadelphia: W. Vol.

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La lista de las afecciones de esta revisión no es exhaustiva y es posible la presentación de otras enfermedades menos frecuentes. Infektiöse. wird aber unglücklicherweise nicht häufig duchgeführt und wenig Berichte in der Literatur schliessen Histopathologie ein. Diese Studie gibt nach einer ätiologischen Übersicht eine Zusammenfassung und Illustration skrotaler Läsionen beim Hund mit dem Ziel. Veterinary Dermatology. Maiolino neoplásico. La presentación clínica de las lesiones. pathologische Reaktionen der skrotalen Haut zu verstehen. das Vorhandensein von primären oder sekundären Läsionen und klinische Zeichen systemischer Erkrankungen können in der Diagnosefindung behilflich sein. hormonelle und neoplastische Erkrankungen sind die häufigsten veröffentlichten Ursachen von skrotalen Läsionen beim Hund. Die klinische Präsentation der Läsionen. Die Liste der hier aufgeführten Erkrankungen ist nicht vollständig und andere seltenere Erkrankungen können angetroffen werden. © 2002 Blackwell Science Ltd. die klinische Erkennung und Diagnose zu erleichtern. 63 – 76 . En algunos casos.76 R. In der veterinärmedizinischen Literatur sind diesem Thema keine Veröffentlichungen gewidmet. 13. Histopathologie zielt darauf ab. la presencia de lesiones primarias o secundarias y la presencia de síntomas clínicos de enfermedad sistémica pueden ayudar en el diagnóstico. immun-bedingte. Zusammenfassung Skrotale Läsionen sind nicht häufig und oft eine diagnostische Herausforderung. um zu einer definitven Diagnose zu gelangen. La histopatología ayuda a comprender las reacciones patológicas de la piel escrotal pero desafortunadamente no se realiza normalmente y pocos estudios incluyen histopatología. Pueden afectar sólo el escroto o también otras áreas corporales. son necesarias otras pruebas diagnósticas para conseguir un diagnóstico definitivo. Sie können ausschliesslich den Hodensack oder auch andere Teile des Körpers betreffen. In einigen Fällen sind weiterführende Untersuchungen nötig. Cerundolo and P.

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