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Skin Problem on Ears

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: My two-month-old daughter has a crust on the outside of one ear. It seems almost like an athlete's foot type of discharge. The ear seems to be a little swollen, also. Her other ear is fine. Please advise.

A: With skin being our body's largest organ, parents are more apt to see a problem. Although it isn't always possible to make an exact diagnosis of a rash without seeing it first hand, what you describe sounds very much like something seen commonly in infants--seborrheic dermatitis. This is an inflammatory condition that can occur at all ages. The appearance of the rash is easily visible and sometimes can be striking. What causes seborrheic dermatitis is unclear, but it isn't something that can be spread to others. It may be related to hormones in pregnancy and the body's oil glands.

You may have heard of "cradle cap"--scaliness and crusting in areas of the scalp--which can be the beginning signs of this skin condition. "Cradle cap" may be the ONLY sign, too. Other times you can see a reddened, bumpy, scaly, almost greasy rash, involving the face, neck, ear (often behind it on the outside), armpit, and diaper regions. It can just be in a specific area or spread to involve the entire body. The rash is usually not itchy and doesn't make the baby uncomfortable.

Seborrheic dermatitis can go away on its own over a few months. Using a mild shampoo while brushing out the scales, or a little stronger "medicated" shampoo (selenium sulfide) to control the scalp lesions is recommended. The response is often good, although it doesn't just rapidly go away. Sometimes more frequent use of the shampoo is necessary. Occasionally topical creams--for example, steroids--are indicated. Your baby's doctor can confirm this rash and how to treat it.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.


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