Dr. Ashwini. V. Swamy
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have a two-year-old son who has a small hole in his ears. It started as a little spot and later degenerated into a small hole in the cartilage. Now it started spreading to another ear. I have gone to many ENT specialists and dermatologists, and they could not be able to figure out what it is. It began as a small dot or spot 17 months ago in the left ear and started becoming a hole. We noticed it in the right ear around seven months ago. In the same way, it started as a dot as seen in the right ear before it turned into a small hole as seen in the left ear. The one on the left ear is 17 months now. We have been to many ENT specialists and dermatologists, and they said they had not seen such a thing before. They conducted a blood test on him and said everything is fine. It is disturbing me a lot and looking for a solution for it as I am scared, that it should not get bigger. I am using Fusibact ointment on the affected area.
Hi,
Welcome to icliniq.com.
With your description and after reviewing the pictures (attachment removed to protect patient identity), I can think of a condition called angiolymphoid hyperplasia with eosinophilia (ALHE). It is a benign harmless condition that presents with bumps in the ears. ALHE is common in adults, but there are few cases of ALHE reported in children as well. This is an idiopathic condition, meaning the cause is not yet known. This condition has to be confirmed by skin biopsy. I understand it is difficult to do a biopsy in kids, but I feel biopsy is essential because this problem is present since 17months as you have mentioned. In about 20 % of cases, there will be elevated eosinophils in the blood. You have told that the blood tests are fine. I am not sure if the eosinophils were tested.
Patient's Query
Thank you doctor,
Are you suggesting biopsy for a two-year-old child? As you said, is it essential as it is present from 17 months ago?
Hi,
Welcome back to icliniq.com.
You have been using an antibacterial cream that does not seem to heal the lesions. Considering the chronic history, after seeing the pictures, it looks like ALHE. Even it is difficult for me to say what it is exactly. Other possibilities are chronic folliculitis and auricular sinus. You can do a biopsy of the skin which will provide more details on the condition. In this way, the exact nature of the problem will be revealed, and the treatment can be focused towards it.
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Venereology
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