## Overview Aural plaques, also known as ear papillomas or papillary acanthoma, are benign, virus-induced lesions on the inner surface of the pinna. They appear as depigmented, hyperkeratotic papules and plaques and are caused by equine papillomaviruses, most likely transmitted by black flies (Simulium species). The condition is common, primarily cosmetic, and usually asymptomatic, although fly bites themselves can cause irritation and head shyness. ## Causes Equus caballus papillomavirus types 1, 3, 4, 5, and 6 have been associated with the lesions. Black flies serve as mechanical vectors, feeding on the relatively hairless inner ear at dawn and dusk. ## Diagnosis Diagnosis is clinical based on the characteristic white, crusty plaques on the concave pinna. Biopsy is rarely needed but confirms papillated epidermal hyperplasia and hyperkeratosis with viral cytopathic effects. ## Treatment Most cases require no treatment. When plaques cause significant irritation, topical 5 percent imiquimod cream applied two to three times weekly has been shown to resolve lesions, although the intense inflammatory response usually necessitates sedation. Fly control reduces discomfort and may limit spread. ## Recovery and Prognosis Prognosis is excellent. Lesions are benign and do not affect general health. Recurrence is possible if fly exposure continues. ## Prevention Fly masks or ear covers, stabling during peak fly activity, and topical repellents reduce transmission and irritation.
white, raised, crusty plaques on the inner surface of one or both ears; occasional head shyness or sensitivity related to fly irritation; no systemic illness
## Overview Aural plaques, also known as ear papillomas or papillary acanthoma, are benign, virus-induced lesions on the inner surface of the pinna. They appear as depigmented, hyperkeratotic papules and plaques and are caused by equine papillomaviruses, most likely transmitted by black flies (Simulium species). The condition is common, primarily cosmetic, and usually asymptomatic, although fly bites themselves can cause irritation and head shyness. ## Causes Equus caballus papillomavirus types 1, 3, 4, 5, and 6 have been associated with the lesions. Black flies serve as mechanical vectors, feeding on the relatively hairless inner ear at dawn and dusk. ## Diagnosis Diagnosis is clinical based on the characteristic white, crusty plaques on the concave pinna. Biopsy is rarely needed but confirms papillated epidermal hyperplasia and hyperkeratosis with viral cytopathic effects. ## Treatment Most cases require no treatment. When plaques cause significant irritation, topical 5 percent imiquimod cream applied two to three times weekly has been shown to resolve lesions, although the intense inflammatory response usually necessitates sedation. Fly control reduces discomfort and may limit spread. ## Recovery and Prognosis Prognosis is excellent. Lesions are benign and do not affect general health. Recurrence is possible if fly exposure continues. ## Prevention Fly masks or ear covers, stabling during peak fly activity, and topical repellents reduce transmission and irritation.
white, raised, crusty plaques on the inner surface of one or both ears; occasional head shyness or sensitivity related to fly irritation; no systemic illness