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A boy aged 14 years presented with itchy small red lumps on the helix of each ear the morning after playing a preseason cricket match for his local club (figures 1 and 2). These lumps evolved into blisters then crusted and healed without scarring over a 10-day period. He was systemically well with no temperatures or other skin lesions, but found to have mild cervical lymphadenopathy. The lumps were noted to recur the following year at the start of the cricket season.
Test your knowledge
What is the most likely diagnosis?
Juvenile spring eruption
Chondrodermatitis nodularis helicis
What investigations should you undertake?
Herpes simplex virus
What are the management options?
Answers can be found on page XX
ANSWERS TO THE QUESTIONS ON PAGE XX
This is a typical history for juvenile spring eruption, a localised polymorphic light eruption. It is a photosensitive skin disorder affecting areas of sun-exposed skin particularly the ears, commonly occurring after the first significant sunshine in spring.1 It is more common in males, as girls’ ears tend to be better protected from the sun by the hair. It may occur in localised outbreaks of school-aged children.2 Itchy papules typically occur 12–24 hours after exposure to ultraviolet light on the helix of the ear. They may progress to blisters which then crust over and heal without scarring. Enlarged cervical lymph nodes may be present.
There are no investigations required—diagnosis is based on the typical history and clinical appearance.3 Management if needed involves topical steroids and emollients. Antihistamines may help with itching. Protecting the ears with sunscreens and hats, or even growing the hair long, may prevent recurrence. It can recur in subsequent years and often has a family history.
This child’s rash resolved spontaneously each year but he will be wearing a wide-brimmed hat for future cricket matches!
Patient consent for publication
This study does not involve human participants.
Contributors GM identified the patient and condition and supported CH in writing this article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.