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Dermatologic Lesions Involving the Ear
 
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A clinical study of 1000 cases of dermatological
diseases involving the ear

Authors: Bhavesh Mehta*, Vinita bhrambhatt**,Ankita Sangwan**, Vikas Sinha****Professor & Head, Dermatology, ** Resident Dermatology, ***Dean & Professor, ENT

Institution:   Shree M.P. Shah Government Medical College

Corresponding Author: 

Dr. Bhavesh Mehta
Professor & Head, Dermatology
Shree M.P. Shah Government medical College,
Jamnagar. (Gujarat, India) 361 008.
drbhavesh_skin@rediffmail.com

Abstract:

Introduction:  A variety of dermatological conditions affect the external ear.  Depending upon the site of these lesions in the external ear, they are either detected early by the patient, a relative or a friend; or are detected at a later stage as in cases of malignancies.  The present study describes the spectrum of these conditions affecting the external ear.

Aims and objective:  To study the incidence of various dermatoses around the ear.

Materials & methods:  A prospective study was conducted at the Dept. of Skin and VD with the help of the ENT Dept.  A total of 1000 patients with ear dermatoses were enrolled, and their clinical history with relevant investigations was noted.

Results: Infectious dermatoses (48.5%) were the most common presentation, while others such as dermatitis (8.5%, keratinizing disorders (7.2%), tumors (6.2%) and bullous disorders (5.4%) were the other presentations.  Pigmentary disorders (2.7%) were comparatively rare.  The peak age at presentation was 31-40 years (47.8%), being predominant in males (62.5%).

Conclusion: Infections are the most common cause of ear dermatoses.  The peak age of presentation is 31-40 years, while being more common in males

 
Introduction:

The ear is an important sensory organ of our body.  Because of its exposed localization, the ear is particularly susceptible to the environment and the effects of ultraviolet (UV) light, and consequently, to pre-neoplastic and neoplastic skin lesions.  Further, it has a sound-transmitting function and is located at a visible, esthetically obvious site, drawing considerable attention from the patient. Depending on the localization, lesions on the external ear may lead the patient to seek professional help when they are noticed by the patient, a relative or friend.  When hidden areas of the outer ear are affected, consultation may be delayed until very late in the disease progression.  This is especially true for malignant tumors, which may often present at an invasive stage, due to the minimal thickness of the skin compared to other parts of the body.

Methods:

We prospectively analyzed the patients having dermatological conditions on and around the ear.  A study of 1000 cases was conducted on patients coming to the Department of Skin, V.D and Leprosy with help of the ENT department.  The study was conducted from January 1st, 2010 to June 30th, 2011.  Each patient was analyzed in detail with respect to history, clinical feature, site of involvement, duration of disease and relevant investigations were done.


Results:

Dermatoses were identified around the ear in 1000 patients.  Among them tinea infection was the most common (9.8%), followed by psoriasis (7.8%), Herpes zoster (6.9%), erythoderma (6.6%) and urticarial (6%).

Classification of Disease
Figure 1:  Classification of Disease
Click on Tables and Figures to Enlarge

Otologic Dermatologic Lesions
Table 1:  Patient Diagnoses
 
 
 
Sex Distribution
Figure 2:  Sex Distribution
Age Distribution
Figure 3:  Age Distribution,  Most patients were
31 to 40 years of age

Discussion:

Tinea faciei is a superficial fungal infection commonly present in hot and humid environments.1  It is commonly present and affects all parts of the body including the face along with the ear.  In patients with psoriasis, especially those with extensive scalp involvement, also have external ear involvement;2 the scaly lesions may accumulate in the external auditory canal which results in decreased hearing.  Herpes zoster involving the trigeminal nerve (also in Ramsay Hunt Syndrome) affects the ear.  Allergic urticaria due to chilblain urticaria commonly affects the ear.3  Seborrheic dermatitis causes little scaling and inflammation at the entrance to the external auditory meatus, in the conchae and in the auricular fold.4  In leprosy, multibacillary types (Lepromatous, borderline lepromatous and Histoid) papulo-nodular lesions involve the whole face and ears (Leonine face of leprosy).  In the DLE, wide follicular pits were seen in the conchae or triangular fossa of the ear.5,6  Various cosmetics, perfumes, hairsprays, hair dyes, and jewelry can produce allergic or irritant contact dermatitis in otitis externa.7  In Atopic Dermatitis, a crusted eczematous fissure at the junction of the earlobe and the face is seen.8,9,10  Comedones frequently involve the conchae and are occasionally found on the helix, tragus or earlobe.  Pressure from spectacle frames and headsets can aggravate acne lesions.  Keloid on the ear is common after ear piercing, viral infection (smallpox, varicella zoster) or after repair of auricular trauma.  Ear keloid can sometimes be pedunculated.  In Darier’s Disease, multiple dirty, warty papules are seen behind the ear.11  Basal cell carcinoma accounts for 90% of all malignant cutaneous lesions in the head and neck regions.12  It is the most common skin cancer of the ear.  It makes up 1/5th of all neoplasms that involve the ear and temporal bone.  24% of squamous cell carcinomas of the head and neck region involve the ear and temporal bone.12,13,14  Sun exposure, fair complexion, radiation exposure and association with HPV are predisposing factors.

Below are pictures of Dermatological Disease involving the ear.  Click on the Pictures to Enlarge

Comedones Contact Dermatitis Darier Disease
Comedones
    
Contact Dermatitis
    
Darier's Diseases
    
Discoid Lupus Eczema Herpes Zoster 
Discoid Lupus Erythematous
    
Eczema
   
Herpes Zoster
   
Intertrigo Ear  Keloid  Lepromatous Leprosy 
Intertrigo Ear
   
Keloid
   
Lepromatous Leprosy
   
Microtia Phemphigus Foliaceous Photodermatitos
Microtia
 
Pemphigus Foliaceus
 
Photodermatitis
 
Tinea Facei Vitiligo Preauricular Tag
Tinea Faciei
 
Vitiligo
 
Preauricular Tag
 

Conclusion:

The outer ear, including the auricle and ear canal, can be affected by a variety of different skin lesions and dermatological conditions. They can be either solitary lesions which are locally limited to the ear or are part of a generalized dermatologic condition.  The outer ear itself plays a functional role in audition by collecting and transmitting sound.  Additionally, it has an important effect on facial appearance and therefore on individual psychological disposition.

 
References:

1. Pravda DJ, Pugliese MM. Tinea faciei. Arch Dermatol. 1978 Feb;114(2):250-2.  View Abstract

2. R.D.R. Camp. Psoriasis. In R.H. Champion, J.L.Burton, F.J.G. Ebling (edi) Text book of Dermatology, 5th edition. London, Blackwell Scientific publication, 1994;1391-1458.

3. Neittaanmäki H. Cold urticaria. Clinical findings in 220 patients. J Am Acad Dermatol. 1985 Oct;13(4):636-44.  View Abstract

4. CM Baruah, V Bhat, Rohit Bhargava, RB Garg, Ku.  Prevalence of dermatoses in the neonates in Pondichery
  Indian Journal of Dermatology, Venereology, and Leprology.  1991;57:25-28  View Abstract

5. Kennedy C. The External Ear: Burns T, Breathnach S, Cox N, Griffiths C.   Rook’s Textbook of Dermatology: Vol 4: 8th ed; Singapore. A John Wiley and Sons, Ltd Publication 2010;68:1-68.

6. Shuster S. A simple sign of discoid lupus erythematosus. Br J Dermatol. 1981 Mar;104(3):350-1.   View Abstract

7. Rebora A. Scarring of the concha as a sign of lupus erythematosus. Br J Dermatol. 1982 Jan;106(1):122.  View Abstract

8. Jones EH. Allergy of the external ear and canal. Otolaryngol Clin North Am. 1974 Oct;7(3):735-48.    View Abstract

9. Voss M, Voss E, Schubert H. [Scaling of the ears--a leading symptom of the ichthyosis group?]. [Article in German] Dermatol Monatsschr. 1982 Jun;168(6):394-7.   View Abstract

10. Sampson HA. Atopic dermatitis. Ann Allergy. 1992 Dec;69(6):469-79.  View Abstract

11. Hyams VJ, Batsakis JG, Michaels L: Tumors of the upper respiratory tract and ear.In Atlas of tumour pathology. Volume 25. Edited by Hartmann WH, Sobin LH. Washington, DC: Armed Forces Institute of Pathology; 1988:343.

12. Thompson AC, Shall L, Moralee SJ. Darier's disease of the external ear. J Laryngol Otol. 1992 Aug;106(8):725-6.    View Abstract

13. Nindl I, Gottschling M, Stockfleth E. Human papillomaviruses and non-melanoma skin cancer: basic virology and clinical manifestations. Dis Markers. 2007;23(4):247-59.   View Abstract

14. Molho-Pessach V, Lotem M. Viral carcinogenesis in skin cancer. Curr Probl Dermatol. 2007;35:39-51.   View Abstract
 

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World Articles in Ear, Nose and Throat  www.waent.org                May 21, 2012              Vol 5-1

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