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Juvenile spring eruption

9 July 2012, by MEUNIER L.

Juvenile spring eruption is a clinically entity that is closely related to polymorphic light erption and arises in children, teenagers and young adults. Boys are more prone as their shorter hair leaves theier ears exposed. The first sign of the eruption is slight itchiness. The skin on the ears then reddens and breaks out into blisters and scabs or more rarely, blisters on the outer edge of the helix. The backs of the hands and forearms may also be involved but this is much less common. The rash only arises in spring time, never in the summer, and is triggered by exposure to the cold in the morning. One or more flares may arise every spring, but the disorder gradually becomes less severe and eventually disappears altogether after a few years.

Histologically, the lesions present as epidermal necrosis associated with exoserosis and may closely resemble both erythema multiforme and bullous toxicodermatosis in appearance. The dermis contains a slight, mainly perivascular, inflammatory infiltrate but no fibrinoid necrosis. Photobiological tests are negative, since the rash is triggered by a combination of spring sunlight and the cold.

The differential diagnoses are acute eczema or herpes of the helix (especially in the rare unilateral forms of juvenile spring eruption). It is difficult to rule out erythema multiforme since they share sometimes very similar clinical and histological features. Lastly, some authors consider that juvenile spring eruption is in fact a localised form of polymorphous light eruption.

The condition has minimal psychological and physical impact and is self-limiting within one to two weeks, without sequellae.

Patients must be informed of the following:

– the cause is unknown, but both sunlight and the cold play a role. Rare familial cases have been reported;

– it is harmless and flares up in the spring. Annual recurrences are possible;

– it generally resolves spontaneously;

– it can be prevented by wearing protective clothing.

It is a harmless, temporary condition; it does not cause any other diseases and long-term monitoring is not required.

Treatment is rarely indicated; short-term corticosteroids may accelerate the healing process and alleviate itching. Wearing a hat during the first sunny but cold days of spring may prevent reucrrence.

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