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Bilateral Pruritic Auricular Papules and Plaques

 


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Am Fam Physician. 2016 Sep 15;94(6):486-489.

A 59-year-old woman presented with several years of persistent and worsening bilateral pruritic auricular lesions. The rash was limited to the ears, and the patient did not have a history of a similar rash on other areas of her body. She reported rubbing and scratching her ears often. A trial of ketoconazole shampoo and triamcinolone cream was ineffective.

Examination revealed cobblestoned, slightly keratotic, brown papules and plaques on the concave surfaces of both ears (Figure 1 and Figure 2). The physical examination was otherwise unremarkable. A punch biopsy of the plaque was performed.


Figure 1.


Figure 2.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Amyloidosis.

B. Colloid milium.

C. Flat warts.

D. Intertriginous granular parakeratosis.

Address correspondence to Zachary Zinn, MD, at zzinn@hsc.wvu.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Mahalingam M, Steinberg-Benjes L, Goldberg LJ. Primary amyloidosis of the auricular concha – a case report and review. J Cutan Pathol. 2000;27:564....

2. Mahalingam M, Palko M, Steinberg-Benjes L, Goldberg LJ. Amyloidosis of the auricular concha: an uncommon variant of localized cutaneous amyloidosis. Am J Dermatopathol. 2002;24(5):447–448.

3. Salim T, Shenoi SD, Balachandran C, Mehta VR. Lichen amyloidosus: a study of clinical, histopathologic and immunofluorescence findings in 30 cases. Indian J Dermatol Venereol Leprol. 2005;71(3):166–169.

4. Brownstein MH, Helwig EB. The cutaneous amyloidoses. I. Localized forms. Arch Dermatol. 1970;102(1):8–19.

5. MacSween RM, Saihan EM. Nylon cloth macular amyloidosis. Clin Exp Dermatol. 1997;22(1):28–29.

6. Weyers W, Weyers I, Bonczkowitz M, Diaz-Cascajo C, Schill WB. Lichen amyloidosus: a consequence of scratching. J Am Acad Dermatol. 1999;37(6):923–928.

7. Pourrabbani S, Marra DE, Iwasaki J, Fincher EF, Ronald LM. Colloid milium: a review and update. J Drugs Dermatol. 2007;6(3):293–296.

8. Prose NS, Von Knebel-Doeberitz C, Miller S, Miller PB, Meilman E. Widespread flat warts associated with human papillomavirus type 5: a cutaneous manifestation of human immunodeficiency virus infection. J Am Acad Dermatol. 1990;23(5 pt 2):978–981.

9. Ding CY, Liu H, Khachemoune A. Granular parakeratosis: a comprehensive review and a critical reappraisal. Am J Clin Dermatol. 2015;16(6):495–500.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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