Eruption over both ears

Abstract

A previously healthy six-year-old Swiss girl who had had an eruption over both ears for approximately 4 days was presented to the emergency service by her parents. Itching and diffuse redness were the initial manifestation, followed by the appearance of red blisters. The child was well and active and had enjoyed playing outside in spite of cold but sunny weather. Vital signs and physical examination were normal except for some small blisters without any honey-coloured crust on the helices of both ears (Figure). Q. What is the likely diagnosis? (Answer on page 252). In this girl with an eruption over both ears, the onset in the spring following sun exposure, the symmetric distribution of rash on both ear helices, its pruritic nature and its localisation, strongly argue for the diagnosis of juvenile spring eruption of the helices of the ears. The patients are typically children, adolescents or young adults with erythematous scaly papules or vesicles on the helices of the ears. Onset occurs in the spring during sunny and cold weather, and symptoms resolve within several weeks, not to recur until the following spring. Boys are more commonly affected than girls because shorter haircuts expose their ears. The diagnosis is typically made on a clinical basis. Juvenile spring eruption of the helices of the ears is likely a quite common and perhaps under-recognized photo-induced eruption, which is considered a localized variant of polymorphous light eruption, the most common idiopathic photodermatosis. Polymorphous light eruption, often called ‘sun poisoning’, usually presents as a pruritic rash in sun-exposed areas that appears hours after sun exposure and persists for days. Treatment of juvenile spring eruption of the helices of the ears is not always needed, because of the temporary nature of the disease. Topical corticosteroids may be helpful to reduce inflammation. It is critical to emphasise sun protection.