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When LE affects the skin of the dorsal hands, erythema and scaling typically spare the knuckles.
This is in contrast with dermatomyositis, where the violaceous erythematous papules typically involves the knuckles.
It is believed that the development of skin toxicity, which is a major adverse effect of EGFR inhibitors, is due to the inhibition of homodimeric EGFR on normal skin cell surface.
The authors propose that this sparing may be either due to decrease in the population of EGFR expressing cells or decrease in the EGFR expression in the irradiated area.
The sign manifests because of the unique combination of the anatomy of the hand and the sweeping movement the hand makes during application.
There are reports of cancer patients who on treatment with recombinant monoclonal antibody against human EGFR, such as cetuximab and erlotinib, develop skin rashes that spare the previously irradiated areas.
Another case that defies classification to one single group is the patient with cutaneous T-cell lymphoma (CTCL), who developed herpes zoster involving the left T8 dermatome.
The ear-lobe sign is seen in those who develop contact dermatitis to a substance applied with one hand to the skin of the face and neck.
On the ipsilateral side of the face, the ear-lobe is spared, whereas, on the contra-lateral side, the ear-lobe is involved.
The author also attempts to untangle the confusion that has risen in connection with these signs.
White or graying hair follicles are commonly spared in AA, and regrowing hair shafts are usually white before they become repigmented.