I grabbed the chart of my next patient and was intrigued by what the nurse had written as the chief complaint.

 

It said, “Red rash on the ears”. When I entered the room, I was warmly welcomed by five-year-old Max who was playing with hot wheel cars on the examining table. He was the most engaging and sociable little guy I had seen in a while. When I asked Mom for details of the history Max offered his version in great detail…most of which was very accurate.

 

Max and Mom stated that this all started about five days ago.

 

After waking up Mom noticed the top part of his ears, the helices, was bright red. They were neither sore nor tender and both ears were symmetrically affected.
 

According to Mom it really did not seem to bother him at all. There was no fever and absolutely no other symptoms.

 

Later that day she noticed that there were clusters of small slightly raised bumps where the redness was. By the following day some of the bumps had formed small blisters that began to itch somewhat. After applying a mild steroid cream Mom was not sure it made much of a difference other than lessen the itch. Today, as he came to the office, some of the blisters had started to crust, leaving areas of a yellow crustiness. Mom was worried about an infection.

 

Max did not have a fever.

 

The only finding of note was his ears which were red with the small blisters and areas of crustiness. He did have some small lymph nodes in his neck but his throat was neither red nor sore. The ears did not look like they were infected.
 

I must say that I was perplexed and so began to dig deeper into the history.

 

I thought it might be a contact type of dermatitis from something he had come into contact with. Had he started using headphones recently? Perhaps he started playing baseball and using a batting helmet that had a foam or synthetic padding which made contact with his ears. Learning that he does martial arts twice a week I asked if he used a head guard with ear protectors. We talked about a new shampoo, hair conditioner or even hair gel that Mom might have used. She answered no to all of these questions which was a bit frustrating.
 

As we were talking Mom took her phone out and scrolled through pictures.

 

Then she stopped and said, “It sort of looks like this”. Sure enough there was a picture of a little boy with ears identical to Max’s. Under the picture the caption read Juvenile Spring Eruption (JSE). I left the room to get a dermatology book and looked at the index. To my surprise there it was on page 147.

 

JSE typically occurs in the late winter or spring when the air temperature is cold, yet there is direct sunshine.

 

It is felt to be a delayed sensitivity reaction to the sun (photosensitivity) and UV exposure. It starts around 8 to 24 hours after being in the sun on a cold day. Just as in Max’s case there is redness and then the formation of small bumps that evolve into blisters or vesicles. These go on to crust and dry. It is a self-limiting condition which means that it will resolve without any treatment. It usually lasts around 10 days. The treatment is merely for comfort. If there is itching the child can be given Zyrtec or Claritin. A mild hydrocortisone cream may help things resolve a bit quicker. An emollient that will moisturize the skin is also recommended.
 

JSE primarily affects young boys between the ages of 5 to 12 years.

 

It is much less likely to occur in girls. It is suggested that this is because girls tend to have longer hair that covers the ears. It can also occur in young adult males but is not very common. A search of the literature shows reports of outbreaks in young boys in Holland, Austria and New Zealand. The one consistent variable was that they all occurred on cold sunny spring days. One paper from New Zealand reported that of 162 young boys in a school, 20 developed the condition during one spring season. It is not infectious or contagious so a child with JSE can go to school and be around other children.
 

I told Mom that I have been in private practice for 40 years and this was a first for me.

 

I don’t recall ever seeing this or actually reading about this condition. I mentioned it to a couple of my partners and they were equally surprised as they had not seen it. That is what is so exciting and stimulating about medicine. Each day is a new experience and just when you think that you have seen it all.