Case of the month : Preauricular tags in a child

Ear tags also known as an accessory tragus or a branchial cleft remnant.

These are benign growths that consist of skin and sometimes cartilage. Ear tags are usually located in front of the ear or on the cheek.

The external ear forms early in development before a baby are born.

Preauricular tags which often contain a core of cartilage appear to represent accessory hillock of His, the hillock that normally develop in the recess of the mandibular and hyoid arches and coalesce to form the auricle.

Ear tags can occur as isolation or may occur in association with genetic syndromes such as Goldenhar syndrome, hemi facial microsoma, first and second branchial arch syndrome (1).

Ear tags are typically discovered at birth.

Some children with accessory ear tags may also have associated hearing loss on the same side (2).

Some ear tags have a narrow stalk (a pedunculated tag) that does not contain any cartilage. Because most ear tags have cartilage within the stalk, the recommended treatment approach is to remove the ear tag by surgical excision.

These tags do not grow back after surgery. All newborns should be screened for hearing loss, whether or not they have preauricular skin lesions (3).

Although there is a reported association between renal tract abnormalities and isolated preauricular skin lesions in infants, studies that have used renal ultrasonography to evaluate these patients are inconclusive. Physicians should not perform renal imaging on newborns with preauricular skin lesions unless they have other congenital malformations. 

Case report

One year and seven months old, male Saudi child reported to our pediatric clinic with history of small pea size, painless swellings on face in front of both ears since birth (Figure 1 and 2).

Obstetric history not significant. Antenatal, natal and post natal period uneventful.

Other siblings are normal.

On examination vital signs were normal.

Growth parameters, with in normal range (weight 11 kilogram, length 85 centimeters, head circumference 45 centimeters).

On examination, alert active child with painless pea size, soft, sessile swellings, skin over it normal. Hearing assessment was normal. No other abnormality detected.

All systems were normal.

Figure 1. Right lateral view of skin tags located in front of the ear (preauricular).

Figure 2.  Left lateral view of skin tags located in front of the ear (preauricular).

Conclusion

Skin tags and pits just in front of the opening of the ear, are sometime present in a neonate.

Preauricular skin lesions are congenital anomalies found anterior to the tragus.

These lesions manifest as protuberant fleshy papules (tags) or superficial dimples (pits), and may be unilateral or bilateral, multiple or solitary.

In most cases, these are normal. However, they can be associated with other medical conditions.

It is important to point out skin tags or pits to your child’s health care provider. American Academy of Pediatrics endorses universal screening to assess for hearing loss in all newborns as outlined by the Joint Committee on Newborn Hearing, regardless of the presence or absence of preauricular skin lesions.

Currently there are no recommendations or guidelines about the role of renal ultrasonography in screening infants with isolated preauricular lesions.

Presence of isolated preauricular skin lesions in newborns does not confer a significantly increased risk of renal anomalies, and that routine renal ultrasonography is unnecessary unless the patient has other major malformations or signs of multiple congenital anomalies (12).

Skin and ear tags will not fall off on their own. There’s no reason to panic if your child is born with one.