A few years ago, a mother brought her young sons to the surgery with crops of itchy blisters along the tops of their ears. I’d never seen anything like it. Both boys were otherwise well, and neither had a single blemish elsewhere.
I reasoned that it must be an allergy, but there was no new hair product that might have set it off. And neither of them wore glasses or a hat or a sweatband: nothing that could have brought a chemical into contact with their ears.
I considered a virus. Many show a predilection for certain areas of skin – hand, foot and mouth disease causes spots in just those three locations. However, “top of the ear disease” seemed unlikely.
I was stumped. But whatever the cause, it looked like some steroid cream to damp down the inflammation would help.
The following week, Annie, one of the other GPs, caught me at coffee time. “I saw those boys,” she said. There was amusement in her eyes. “It’s juvenile spring eruption.”
She filled me in. JSE is one of medicine’s curios. It’s a seasonal phenomenon, in which the first spell of spring sunshine provokes an itchy, blistering rash that is confined to the tops of the ears. Intriguingly, it occurs in sporadic outbreaks, thought to be because a combination of strong sunlight and particularly cold air is required.
Boys are more commonly affected, presumably because of short-back-and-sides. People grow out of it during their teens, hence the specific age group.
JSE is treated with steroid cream (at least I’d got that right) and by avoiding strong sunlight, which Annie had been able to advise the boys’ mum about when they came for review.
Much diagnosis is pattern recognition. If I’d encountered JSE before, I would have known instantly what I was dealing with. Because I hadn’t, I’d been left figuring it out from first principles. I had deduced the basics – an external agent causing inflammation – but I kicked myself for not considering sunlight. I’ve seen many UV reactions, most commonly when a medication has sensitised the skin, but they have a tell-tale distribution, affecting all areas exposed to sun. In JSE, chill air sensitises the peripheral ears alone.
The case came to mind recently when Jeremy Hunt – admitting that NHS 111 is woefully short of clinician involvement – advised parents to google their children’s rashes instead. This caused an outcry among doctors, concerned that parents might waste crucial time trying to work out if the non-blanching rash really was life-threatening meningococcal sepsis. However, I wondered whether Hunt’s approach might be useful for a benign, esoteric condition such as JSE.
Searching under “itchy rash ears” did throw up a few medical articles with JSE mentioned in the small print, but nothing that would be of help to the uninitiated. Much more use were the long threads on three different Mumsnet-type sites. Post after post expressed delight at having encountered others with the same puzzling problem. Astutely, several contributors remarked on the preponderance of boys, and some whose children had been affected in previous years made the seasonal connection. Pollen was considered as a cause – logical, given common knowledge of another seasonal condition, hay fever. Posts from 2010 speculated whether the Icelandic volcanic ash cloud might be responsible, a lovely illustration of our tendency to link unusual events causally.
Posts reporting medical consultations showed I was far from the only doctor never to have encountered JSE. But on every thread someone eventually took their child to an Annie and JSE was diagnosed. Once it was, it made perfect sense to everyone, and the threads closed in a welter of well-I-nevers.
No one made the diagnosis solely from their own internet research; doctors aren’t entirely redundant. But medicine is such a vast field, we medics have to keep learning. I haven’t come across another case of JSE since those boys, but every springtime I wonder whether this will be my year to shine.
This article appears in the 02 Mar 2016 issue of the New Statesman, Germany's migrant crisis