Dr Keith Hopcroft continues our series of fascinating but often unrecognised conditions
The case
‘Can chicken pox just affect your ears?' asks a young mother, presenting her seven-year-old son for my inspection. Apparently, the boy had been in contact with chicken pox about two weeks earlier and has subsequently developed a localised blistering rash while enjoying his Easter holiday in the Canary Islands. ‘We only got back yesterday,' she continues, ‘and I wasn't really sure whether it was okay for him to get on the plane.'
Apart from the rash on his ears – a mixture of papules, vesicles and scabs – the child seems well, with no rash elsewhere and no lymphadenopathy, and is taking no medication.
The diagnosis
This isn't chicken pox – it is juvenile spring eruption (JSE). It's thought to be a type of polymorphic light eruption, a common photosensitive skin disorder.
The exact prevalence is unknown, but it probably affects up to 10% of children aged 5-12 – girls less than boys, perhaps because their longer hair provides some ‘shade'. Predictably, and unluckily, children with ‘bat ears' are more likely to be affected.
Further tests are unnecessary – this is a clinical diagnosis.
Typical features
Papules, vesicles or even bullae appear on the ears, up to a day after sun exposure. Typically, this occurs after the first significant sunshine in spring, though it may persist through the summer. It can recur in subsequent years, and there may be a positive family history.
Treatment
JSE is harmless and self-limiting, though it can cause itching or soreness. If these symptoms are troublesome, steroid creams and antihistamines may prove helpful. Sunscreens and hats – or even growing the hair long – may prevent recurrence.
Issues for the GP
Failing to make a specific diagnosis would not have resulted in any significant harm in this case, as the condition is benign and self-limiting.
But, in these situations, parents find a ‘label' reassuring – plus a clear diagnosis will result in targeted advice about treatment and prevention.
Take-home point
JSE is usually a ‘spot' diagnosis. If the appearance isn't characteristic, the timing and a possible family history should help the GP.
Dr Keith Hopcroft is a GP in Laindon, Essex
