Juvenile spring eruption: clinicopathologic features and phototesting results in 4 cases

Juvenile spring eruption among soldiers: A report of a large outbreak

Juvenile spring eruption is a rare photodermatosis characterised by papules and vesicles appeared on the helix of the ears. A combination of environmental factors including sunlight and cold has been postulated in the pathogenesis. Herein, 58 soldiers with juvenile spring eruption from a single military unit are reported and the characteristics of other reported outbreaks among soldiers are reviewed. [Correction added on 14th November 2020, after first online publication: "The last sentence of the abstract section has been revised."].

Recent Developments in the Diagnosis and Management of Photosensitive Disorders

Photodermatoses occur in males and females of all races and ages. Onset can be variable in timing and influenced by genetic and environmental factors. Photodermatoses are broadly classified as immunologically mediated, chemical- and drug-induced, photoaggravated, and genetic (defective DNA repair or chromosomal instability) diseases. Advances in the field have led to improved recognition and treatment of many photodermatoses. The purpose of this focused review is to provide an update on the diagnosis and management of a variety of photodermatoses, both common and less common, with review of recent updates in the literature pertaining to their diagnosis and management.

Juvenile Spring Eruption: A Variant of Perniosis?

Juvenile spring eruption (JSE) is a unique condition that typically affects the helices of the ears of boys and young men. The classical clinical picture of JSE includes the abrupt onset of lesions after spending time outdoors in the early spring. Because of the papulovesicular nature of the rash and the history of sun exposure, JSE is considered a variant of polymorphous light eruption. In addition to the term "juvenile spring eruption," this entity has also been described under other less common terms such as "perniosis juvenilis vernalis aurium" or "spring perniosis," which emphasizes the onset in the spring and the possible pathogenic role of cold weather. We present a case of likely JSE with histopathologic features more consistent with perniosis than polymorphous light eruption and present a review the literature.

Evaluation of patients with photodermatoses

The systematic evaluation of photosensitive patients involves a comprehensive history, physical examination, phototesting, and, if necessary, photopatch testing and laboratory evaluation. Polymorphous light eruption, chronic actinic dermatitis, solar urticaria, and photosensitivity secondary to systemic medications are the most commonly encountered photodermatoses in dermatology clinics worldwide.

Juvenile spring eruption: an outbreak report and systematic review of the literature

BACKGROUND

Juvenile spring eruption of the helices of the ears is a distinctive sun-induced condition appearing on the light-exposed skin of the ears, typically in boys and young men in early spring.

OBJECTIVES

To determine clinical features and outcome of juvenile spring eruption of the ears.

METHODS

We report a new outbreak in 14 Swiss-Italian children. A systematic search of the literature was also performed.

RESULTS

Five outbreaks in children involved a total of 203 cases (boys, 72%), and three outbreaks in young adults involved 223 male subjects. A further 54 sporadic cases were found: 41 among children (boys, 97%) and 13 among young adult males. The typical presentation included itching and diffuse erythema of both ears starting in the evening after exposure to bright sunlight during cold weather, followed within 24-48 h by papules or blisters. No other organ system was involved. The subjects recovered spontaneously without sequelae within 1-2 weeks. In New Zealand, among 162 school-aged boys, 20 developed the condition.

CONCLUSIONS

A limitation is that the analysis was based upon the scanty available literature. Juvenile spring eruption is a self-limiting and generally easy recognizable variant of polymorphic light eruption. Outbreaks tend to appear on sunny and cold spring days. Paediatricians and general practitioners might rapidly develop the skills necessary to clinically appreciate this condition.

Update on pediatric photosensitivity disorders

PURPOSE OF REVIEW

Although rare in the pediatric population, photosensitive dermatoses may begin prior to adulthood. The causes of photosensitivity are diverse, ranging from primary, immunologically mediated disorders of photosensitivity to inherited genetic or metabolic disorders. This review will highlight the key features of these disorders to familiarize the pediatric practitioner with their symptoms and any associated extracutaneous clinical or laboratory findings that may accompany them.

RECENT FINDINGS

New developments in the field of pediatric photosensitivity have been scant over recent years. While mechanisms of photosensitivity and genetic underpinnings associated with various conditions such as xeroderma pigmentosum continue to be uncovered, the literature on disorders of photosensitivity has been otherwise without many recent significant advances.

SUMMARY

Although the differential diagnosis of pediatric photosensitivity disorders is broad, it is often possible to establish the diagnosis by following an algorithmic approach. Once the correct diagnosis is rendered, this will guide any further workup that needs to be performed as well as specific management strategies.

Photosensitivity disorders in children: part I

Photosensitivity disorders in children encompass a diverse group of diseases. Compared to adult patients, underlying systemic disorders, including genetic or metabolic defects, are common causes in pediatric photosensitivity disorders. Photosensitivity in a child should be suspected if the child develops a sunburn reaction in sun-exposed sites after limited sun exposure. Diagnosis of a photodermatosis is made based on careful history taking and a physical examination. Early recognition and prompt diagnosis are essential to minimize long-term complications associated with inadequate photoprotection. In part I of this continuing medical education article, immunologically mediated photodermatoses, photodermatoses caused by exogenous photosensitizers, and the cutaneous porphyrias will be covered.

'Lambing ears': a blistering disorder affecting farmers at lambing time

BACKGROUND

At lambing time some farmers experience blistering and crusting of the pinnae. This occupational disease, termed 'lambing ears', does not feature in the medical literature.

OBJECTIVES

To define the condition and explore its pathogenesis.

METHODS

We obtained five biopsies from affected individuals and sent questionnaires to 69 farmers in the U.K. Farming communities abroad were also contacted.

RESULTS

The eruption lasts for the duration of the lambing practice. The histological features are dominated by a pandermal perivascular and diffuse, predominantly T-cell lymphocytic infiltrate. Only the pinnae are affected and its incidence is related to the degree of involvement a farmer has with the animals around parturition. The condition also occurs, but less frequently, in farmers who are calving.

CONCLUSIONS

This occupational disease occurs with close contact to lambing ewes or calving cows. The histology and distribution are comparable with the juvenile spring eruption variant of polymorphic light eruption, but its demographics are unique.

Juvenile Spring Eruption: A Report of Two Cases

Juvenile spring eruption is a photodermatosis characterized by the development of papules and vesicles on the light-exposed helix of the ears after sun exposure, usually in the springtime. It mainly affects boys and young male adults, and has a tendency to occur in the form of small epidemics. We report an outbreak in a group of soldiers who were performing military exercises during cold and sunny weather during a midwinter season. The clinicopathologic features and laboratory test results are described in two of these cases.