IntroductionRed Ear Syndrome (RES) is a condition often considered to be a localized form of erythromelalgia. It can be related to structural cervical defects or idiopathic. RES is generally very difficult to treat. DiscussionA 57-year-old male presented to the dermatology clinic complaining of a 4-month history of intermittent redness and severe burning of bilateral ears. On examination, the patient exhibited edematous erythema and tenderness to palpation affecting the right and left ear and right malar cheek. A skin biopsy revealed mild superficial perivascular lymphocytic infiltrate with hypertrophy of endothelial cells. The patient was found to have a normal lab work-up including complete blood count, metabolic panel, erythrocyte sedimentation rate, anti-nuclear antibody and type II collagen antibody. A diagnosis of Red Ear Syndrome was made. After failing multiple medications over several months, the patient was started on aspirin and paroxetine which was gradually titrated until he was completely asymptomatic. To date, there is only one other case presentation illustrating the effectiveness of this treatment regimen. ConclusionThere are a limited number of cases describing idiopathic RES with inconsistent results in treatment. With a relatively small number of cases reported, further research is needed into the pathophysiology of RES along with the dual therapy of aspirin and paroxetine in patients that suffer from both primary and secondary RES.

A 22-year-old man with no significant medical history presented with a hard, subungual nodule on his right distal index finger that had been slowly enlarging for 7 years. He complained that the lesion was tender particularly while working with his hands. The patient denied any trauma to the area prior to the lesion appearing. The lesion was unsuccessfully treated by a primary care physician with liquid nitrogen. On physical examination, the lesion appeared as a 1.3-cm hard, traumatized, skin-colored subungual nodule involving the right distal index finger (Fig 1). A punch biopsy was obtained with hematoxylin-eosin staining (Fig 2). Question 1: What is the most likely diagnosis? A. Subungual osteochondroma B. Phalangeal chondrosarcoma C. Superficial acral fibromyxoma (SAFM)