Beyond the surface: Paediatric skin findings as indicators of ear, nose and throat disorders

Atopic dermatitis (AD) and allergic rhinitis

AD frequently coexists with allergic rhinitis, constituting part of the ‘atopic march’.^[2] Children with AD often exhibit allergic shiners, Dennie-Morgan folds and chronic nasal congestion. Pruritus and excoriation may exacerbate secondary infections, such as Staphylococcus aureus or Herpes simplex virus, which can lead to complications like eczema herpeticum. Early intervention in AD may mitigate the progression to allergic rhinitis and asthma.

Psoriasis and otitis external

Psoriasis, a chronic inflammatory dermatosis, can affect the external auditory canal, resulting in psoriatic otitis externa.^[3] Erythematous, scaly plaques within the ear may mimic chronic otitis externa, requiring differentiation for appropriate management. Involvement of the nasal mucosa and lips in psoriasis is rare but can contribute to upper respiratory discomfort and dryness.

Seborrheic dermatitis and otitis media

Infantile seborrheic dermatitis, characterised by greasy scales and erythema, can extend to the external ear, potentially predisposing children to secondary infections, including otitis externa and media.^[4] Malassezia species, which play a role in seborrheic dermatitis, may also be implicated in chronic otitis externa.

Tuberous sclerosis complex (TSC) and ENT involvement

TSC presents with facial angiofibromas, periungual fibromas and hypopigmented macules. ENT involvement includes rhabdomyomas of the larynx and nasal polyps, necessitating vigilant screening.^[5] Laryngeal rhabdomyomas can cause airway obstruction, requiring prompt ENT intervention.

Vascular anomalies: Haemangiomas and lymphatic malformations

Infantile haemangiomas located in the parotid or subglottic region can cause airway obstruction, leading to stridor or feeding difficulties.^[6] Lymphatic malformations involving the neck and face require early evaluation by an ENT specialist for potential respiratory compromise. Large facial haemangiomas may be associated with PHACE syndrome, which includes cerebrovascular anomalies and auditory complications.

Gianotti–Crosti syndrome and viral ENT infections

Papular acrodermatitis is associated with viral infections, including Epstein–Barr virus and hepatitis B, which may present with symptoms such as pharyngitis, lymphadenopathy, or hepatosplenomegaly.^[7] Clinicians should monitor for concurrent viral tonsillitis or otitis media in affected children.

Primary immunodeficiency disorders

Children with recurrent ENT infections and associated dermatologic findings, such as eczema in Wiskott–Aldrich syndrome or cutaneous abscesses in chronic granulomatous disease, warrant immunologic evaluation.^[8] Hyper-immunoglobulin E syndrome (Job’s syndrome) presents with eczema, recurrent skin abscesses and recurrent otitis media.

Kawasaki disease and mucocutaneous ENT manifestations

Kawasaki disease, an acute vasculitis, presents with fever, polymorphous rash, conjunctival injection and mucositis, including strawberry tongue and pharyngeal erythema.^[9] Cervical lymphadenopathy and otitis media are common ENT complications requiring differentiation from bacterial infections.

Hand, foot and mouth disease (HFMD) and oral ulcerations

Caused by coxsackieviruses, HFMD presents with vesicular eruptions on the palms, soles and oral mucosa, leading to significant oral discomfort and feeding difficulties.^[10] ENT involvement includes herpangina, characterised by painful vesicles on the soft palate and oropharynx.

Epidermolysis bullosa (EB) and airway involvement

EB, a group of genetic disorders that cause skin fragility, can lead to oral mucosal erosions, hoarseness, and airway strictures.^[11] Laryngeal and oesophageal involvement in severe EB subtypes requires ENT intervention for airway management.

Papular urticaria and arthropod bite reactions

Hypersensitivity to insect bites can lead to chronic papular urticaria, often involving the face and auricular region. Secondary bacterial infections can result in perichondritis or lymphadenopathy, necessitating evaluation by an ENT specialist.

Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN)

Severe drug reactions such as SJS and TEN present with mucocutaneous involvement, including painful erosions of the oral mucosa, conjunctivitis and pharyngeal ulcerations.^[12] ENT specialists play a critical role in managing airway compromise in these conditions.

Langerhans cell histiocytosis (LCH) and ENT manifestations

LCH can present with seborrheic-like skin lesions, otitis externa and chronic mastoiditis.^[13] Skull involvement can lead to destructive lesions affecting the temporal bone, necessitating ENT imaging and intervention.

The intricate relationship between dermatologic and ENT conditions necessitates a high index of suspicion among paediatricians, dermatologists and otolaryngologists. Early recognition of skin findings can facilitate timely ENT evaluation, preventing complications such as airway obstruction, recurrent infections and hearing loss. Furthermore, targeted therapy addressing both dermatologic and ENT manifestations improves overall patient outcomes.^[14] Multidisciplinary collaboration is crucial in managing complex cases where dermatologic signs may be the first clue to a significant ENT disorder.