Mystery Lesions/ Rash On Sensitive Part of Body - Please Help

Hello! I’m a 32 year old male, 6’0” tall, 150 lbs, in general good health, seeking some dermatology advice. I have been seeing a dermatologist over the last month but am seeking help to settle my nerves and/or bring ideas to my doctor. This is a throwaway account specifically for this question

Since about 2020, I have had a recurring rash on my scrotum and anus. The rash appears on the bottom of the scrotum and sides where it rests against my underwear and thighs. It has since crept up and around my anus. It first appears as a pink, burning rash about the size of a pinhead, this grows to an angry red painful lesion about the size of a dime, then the skin dies and peels off in a thick layer. After peeling off, the raw skin beneath burns, heals, and the cycle repeats regularly. Since early adulthood (early 20’s) there has been some seasonal peeling in this area, but it only began burning like this in 2020. It’s at its worst when moist - sweating and showering are all painful

Prior to seeing a dermatologist, these were my failed solutions to the rash:

1. Change of underwear

2. Change of soap

3. CeraVe moisturizer

4. Vaseline

5. Store brand moisturizer

6. Store brand anti fungal

7. Anti fungal spray

8. Clotrimazole cream

9. Nizoral shampoo

If I applied Cortizone 10 daily, it seemed to keep the rash away, but as a steroid cream, this seems like less than optimal as a solution. If I ceased applying Cortizone 10, the rash would come back. I have been tested for STD’s/ STI’s and have had extensive conversations about sexual health with my GP. This is not that

Eventually, my GP prescribed Clotrimazole and Betamethasone cream 1%/ 0.05% base for me to try while awaiting my dermatologist referral. This works for flare ups. I apply the cream to the affected skin, and it speeds along the peeling process. It often leaves me relieved and clear for 28-30 days afterwards. However, it always returns.

My dermatologist has been able to provide me with the following tests/ treatments:

1. A staph infection swab tested positive for a mild staph presence. My dermatologist provided an antibiotic, which cleared and relieved the affected area for 28-30 days before symptoms reappeared

2. My dermatologist prescribed the stronger steroid clobetasol propionate ointment, 0.05%. When used as prescribed, the affected area cleared, and I was relieved again for about 28-30 days

3. My dermatologist applied a standard allergy test as back patch, revealing no major allergic reaction

The next step is to biopsy, which has me nervous. I’m astounded at the one constant - treatments clearing the area for 4-5 weeks. Is this a significant data point? Does anyone out there have suggestions/ recommendations on what this might be? Autoimmune? Cancerous?

Other health factors: I’m a vegetarian and an habitual nicotine user

Thank you!