Finding small spots or bumps on the scrotum is common and often leads to concern. The scrotal skin is unique, being thinner and more elastic than most other areas, and houses numerous glands and hair follicles. Many of the “dots” people notice are simply normal anatomical structures or harmless skin variations. Understanding these common structures can provide immediate reassurance, but any new or changing growth warrants professional evaluation.
Common and Harmless Skin Structures
Many small bumps are Fordyce spots, which are enlarged sebaceous glands, or oil glands, that lack an associated hair follicle. These spots are present in almost everyone and typically appear after puberty. They are small, pale, yellow, white, or flesh-colored, usually measuring between one and five millimeters. Fordyce spots become more pronounced when the skin is stretched, but they are not contagious or a sign of disease.
The bases of hair follicles can also appear as raised, slightly pigmented dots, especially in areas with coarse hair. Ingrown hairs are a frequent cause of minor, temporary bumps, resulting when a hair curls back and grows into the skin. Eccrine sweat glands, which regulate temperature, can sometimes look slightly raised or prominent at their surface openings. These structures are part of the normal skin anatomy and require no treatment.
Benign Non-Infectious Conditions
Several other benign conditions can manifest as dots or small lumps on the scrotal skin. Angiokeratomas of Fordyce are small vascular lesions resulting from dilated blood vessels near the skin’s surface. They present as dark red, purple, or black spots, often one to five millimeters in size. They can sometimes be mistaken for warts due to their rough or pebbled surface, but angiokeratomas are permanent, not contagious, and generally harmless.
Epidermoid cysts, sometimes called inclusion cysts, are common findings that present as firm, slow-growing lumps beneath the skin. They are typically skin-colored or yellowish and form when skin debris and keratin build up within a blocked hair follicle or sebaceous gland. These cysts are benign, though they can range in size and may become inflamed or painful if they rupture or become infected.
Potential Signs of Infection or Underlying Issues
While many dots are benign, certain appearances can signal an underlying infection or issue, necessitating a medical diagnosis. Molluscum contagiosum, a viral skin infection, causes small, dome-shaped bumps that are typically white, flesh-colored, or pink. The distinguishing feature of these lesions is a characteristic tiny central indentation, known as an umbilication.
Genital warts, caused by the human papillomavirus (HPV), can appear as flesh-colored or whitish growths that are bumpy, flat, or resemble small pieces of cauliflower. Folliculitis, an inflammation or infection of the hair follicles, presents as red, tender bumps that may contain pus. Herpes simplex virus (HSV) typically begins as a cluster of small, discolored bumps or blisters that soon break open to form painful, open sores or ulcers. These lesions are often preceded by localized tingling or itching.
Identifying Red Flags and Seeking Professional Guidance
It is prudent to consult a healthcare provider if a dot or lump is accompanied by specific “red flag” symptoms. A visit is necessary if the spots are painful, itchy, or cause a burning sensation, or if they suddenly bleed or ooze discharge. Rapid growth, a sudden increase in lesions, or the development of open sores also require professional attention.
Other symptoms, such as an accompanying fever, swollen lymph nodes in the groin, or any change in the feel or size of the testicle, should prompt immediate consultation. While many scrotal dots are benign, only a medical professional can accurately distinguish between a harmless variant and a condition that requires treatment. Early diagnosis ensures appropriate management.