Psoriasis Vulgaris, the most common form of the condition, can manifest in the ear, creating a challenging situation for treatment due to the delicate anatomy of the area. This manifestation, often called ear psoriasis, involves the rapid turnover of skin cells, leading to scaly, inflamed plaques in and around the ear structure. Managing this requires caution to avoid damaging the ear canal or the tympanic membrane (eardrum). Given the risks of temporary hearing loss or secondary infection, it is recommended to consult a dermatologist or an ear, nose, and throat (ENT) specialist before initiating any treatment.
Understanding the Sensitive Areas of the Ear
Psoriasis commonly affects several distinct parts of the ear structure. The outer ear, known as the pinna, often shows the typical red patches and silvery scales of plaque psoriasis. The skin folds immediately behind the ear (post-auricular area) are also frequently affected, which can be prone to inverse psoriasis—red, smooth, and non-scaly plaques.
The most sensitive area is the external auditory meatus, the entrance to the ear canal. When psoriasis affects the ear canal, the buildup of excess skin cells and scales can mix with earwax, leading to a physical blockage and temporary conductive hearing loss. Applying thick creams or ointments inside the ear canal should be avoided, as this can push debris further inward or trap moisture, increasing the risk of secondary bacterial or fungal infection (otitis externa).
Over the Counter Relief and Management
For mild symptoms affecting the outer ear, non-prescription options can provide symptomatic relief. Gentle moisturizing is a first step, using simple emollients like petroleum jelly or fragrance-free moisturizers on the outer ear and the skin behind it. These products help to soften scales and reduce dryness and irritation, which can alleviate the persistent itching often associated with psoriasis. It is best to choose a non-comedogenic option for the skin folds behind the ear to prevent clogging pores.
Washing the outer ear should be done using mild, pH-neutral cleansers, which are less irritating than harsh soaps. The goal is to gently remove loose scales without causing further trauma to the inflamed skin. Warm compresses may be applied to the outer ear for temporary relief from discomfort and itching. It is important to resist the urge to pick at or scratch the scales, as this mechanical irritation can trigger a worsening of the psoriatic plaques.
Prescription Treatments for Ear Psoriasis
When over-the-counter options do not control symptoms, a physician will prescribe targeted medical interventions. Topical corticosteroids are the most common first-line treatment, often in a low-potency formulation like hydrocortisone for the outer ear. Stronger steroids can be used on the pinna for short courses, but prolonged application carries a risk of skin thinning, known as atrophy, which is a concern in the thin skin of the ear. When the ear canal is involved, the medication is often prescribed in a liquid solution or drop form, which is safer and penetrates the canal more effectively than thick creams.
Calcineurin inhibitors, such as tacrolimus and pimecrolimus, represent a valuable alternative, especially for sensitive areas like the skin folds and the entrance to the ear canal. These non-steroidal agents work by modulating the immune system and do not carry the same risk of skin atrophy as long-term steroid use.
Vitamin D analogues, like calcipotriene, may also be prescribed to slow the excessive skin cell growth characteristic of psoriasis. These can sometimes cause irritation in sensitive areas and are frequently used in combination with a corticosteroid to enhance effectiveness while minimizing side effects.
For severe or widespread psoriasis where ear involvement is part of a broader condition, systemic treatments may be considered. These medications, including oral drugs or injectable biologics, target the underlying immune system processes throughout the body. However, they are rarely used for isolated ear psoriasis and are reserved for cases that have failed to respond to topical therapies.
Techniques for Safe Application
The method of application is just as important as the medication chosen, particularly when treating the delicate ear area. Creams and ointments should only be applied to the outer ear and the skin behind it, using a thin layer rubbed gently into the affected areas. Thick preparations should not be forced into the ear canal, as they can create a blockage or interfere with the natural self-cleaning process of the ear.
If prescription drops are used for the ear canal, the correct technique ensures the medication reaches the affected area safely. The head should be tilted to the side so the affected ear is facing upward, and the outer ear should be gently pulled to straighten the ear canal. After instilling the prescribed number of drops, the head should remain tilted for a minute or two to allow the liquid to fully coat the canal lining. The dropper tip must never touch the ear to prevent contamination.
Cotton swabs should not be used for any application or cleaning. These devices push scales, wax, and debris deeper into the ear canal, potentially causing impaction or trauma to the eardrum. If significant scale buildup causes muffled hearing, a healthcare provider should be consulted for safe mechanical removal.