History: This 16-year-old boy was seen for evaluation of a retroauricular dermatitis that has been present for 3-4 years. He is in his usual state of health. He does not have a history of atopy. He does not wear glasses.
O/E: Honey-colored crusting in the superior retroauricular sulci bilaterally.
Clinical Photo:
click image to enlarge
Lab: Culture positive for many Staph. aureus with usual sensitivities.
Histopathology: N/A
Diagnosis or DDx: Retroauricular Dermatitis: This is felt to be a marker for atopic dermatitis or atopy. However, this boy is not atopic and the finding may not be all that specific. There is only one article has appeared on this subject (see Reference).
Treatment: The patient was given a sample tube of retapamulin ointment (Altabax) to use b.i.d. for one week. The next photo shows appearance after one week of use as monotherapy. I plan to now use fluocinalone 0.025% ointment daily for a week or two for the residual dermatitis. This may well recur. The natural history of retroauricular dermatitis is poorly defined. There is only one article in the medical literature that discusses this entity.
status post 0ne week of retapamulin ointment
Questions: Does anyone have any comments on this entity? How often do you see this? I see one or two cases a year.
Reason(s) Presented: For interest. It is curious that there are no more reports on this since it appears to be an entity.
References:
Marks MB, et. al. An unsuspected sign of cutaneous allergy. J Am Acad Dermatol. 1981 May;4(5):519-22.
An eczematous eruption in the superior retroauricular areas of the scalp and often
on the posterior aspects of the pinnas may be seen in about 30% of allergic
children. The eruption is not generally noticed because the overhanging hair covers
the affected areas. The dermatitis is seen mainly in those children afflicted with
bronchial asthma, perennial allergic rhinitis, or both. A previous history of atopic
or seborrheic dermatitis is, as a rule, not elicited.
My old partner used to refer to this as infectious eczematoid dermatitis, and treat it (this was years ago, remember) with chloramphenicol in triamcinolone 0.05% ointment - and I don't recall a single treatment failure.
ReplyDeleteI see this more frequently; perhaps 2 or 3 per month. As far as i remember the suggeted term in Rook's textbook is what Dr. Stone just mentioned: "Infectious eczematoid dermatitis". The usual therapy is antibiotic+steroid (as what you prescribed).
ReplyDeleteAltabax is not available in my country. Do you find it very superior to mupirocin?
Cheers,
Omid
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ReplyDeleteThe most amazing part of this presentation is the lack of any other-Atopy symptoms.
ReplyDeleteCulture of Staph, would surely raise the question as to whether it was a supra-added infection secondary to dermatitis (? atopic) or the primary one?
Local antibiotics followed by topical steroids seem to resolve this condition.
I haven't used it (Altabax) yet
ReplyDeleteI prefer calling is RETRIAURICULAR DERMATITIS, though it may be Infrauricular or Suprauricular. Initially there is fissuring which may be associated with erythema and /or crusting showing secondary infection. I have seen several hundred cases here in Middle East. This condition has been documented only ONCE in 45 children. NO further observation has been reported. Though Seborrheic Dermatitis and Atopic cases present with this condition commonly, nevertheless there is a sizeable number of cases in isolation as in this report...
ReplyDelete