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Identifying and managing external ear problems

Keratoacanthoma

These often appear rapidly over a period of weeks, and look alarmingly like squamous carcinomata. They often appear in sun-damaged skin with a central keratin core or plug, and although usually solitary, they can be multiple. They often regress spontaneously, but if not, surgical excision seldom presents much difficulty, although may leave an unsightly scar.

Tinea infection

Fungal infection of the soft tissues of the pinna may produce a nodular appearance that can be confused with some of the aforementioned lesions. The responsible organism is a member of the trichophyton family and is usually responsive to systemic antifungal treatment. But this is a rare disease that should only be diagnosed when all other causes are excluded.

Sebaceous cysts are frequently seen in the lobule, and also in the post-auricular fold, particularly in young men; they may be multiple and when infected, may swell up alarmingly. They are distinguished from tinea and the tumours mentioned above by a punctum which is invariably present though often difficult to find.

It is usually possible to express some sebaceous material with its characteristic smell. Sebaceous cysts are best treated by surgical excision which should include an ellipse of skin containing the punctum. Incisional drainage inevitably results in recurrence.

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