At a Glance - Juvenile spring eruption vs perniosis

Juvenile spring eruption

Juvenille spring eruption


Clinical features

  • Localised polymorphic light eruption.
  • Usually presents in early spring.
  • More common in boys and young men with short hair, as their ears are exposed.
  • Presents within 24 hours of sun exposure.
  • Itchy papulo-vesicular rash on the auricle. May form blisters.
  • Enlarged cervical lymph glands.
  • Healing occurs spontaneously within two weeks.
  • Tends to remit in summer but may recur each year.


Management

  • Treatment speeds healing.
  • Emollients.
  • Topical potent steroid.
  • Antihistamines for itching.
  • Recurrences reduced by growing hair, wearing hats and using sunscreens.


Perniosis of the ear

Perniosis may ulcerate

Clinical features

  • Most common in women and sometimes familial.
  • Induced by cold, damp situations.
  • Perniosis (chilblains) may also affect extremities, ie feet and hands, fingers, toes and nose.
  • May also occur in association with lupus erythematosus (LE), viral hepatitis, HIV, rheumatoid arthritis and chronic myelomonocytic leukaemia.
  • Recurrent, painful, tender erythematous/violaceous plaques on the auricle.
  • May complain of itchy and burning sensation.
  • May blister and ulcerate.
  • Usually occur during the winter months.
  • Perniosis is usually a clinical diagnosis but investigate if in doubt.
  • Skin biopsy.
  • Positive antinuclear antibodies would suggest LE.


Management

  • Avoid exposure to cold.
  • Nifedipine 10mg three times daily or 20mg twice daily.
  • Nicotinamide 500mg three times daily.
  • Topical hexyl nicotinate.
  • Amlopidine 2.5-5mg daily.
  • UV light to affected areas at the start of the cold season.
  • Sympathectomy in severe cases.

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

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