What are the treatment options for eczema (atopic dermatitis) of the external ear?

From the Guidelines

To treat eczema in the external ear, start with gentle cleansing using warm water and mild soap, followed by thorough drying, and apply a topical corticosteroid cream such as hydrocortisone 1% or triamcinolone 0.1% to reduce inflammation and itching, as recommended by the most recent guidelines 1. When managing eczema in the external ear, it's essential to consider the potential for irritation and infection.

• Gentle skin care is crucial, and patients should avoid using harsh soaps or detergents that can strip the skin of its natural oils 1.
• Topical corticosteroids are the mainstay of treatment for atopic eczema, and their use should be guided by the principle of using the least potent preparation required to keep the eczema under control 1.
• In addition to topical corticosteroids, patients may benefit from the use of emollients to maintain the skin barrier and prevent dryness 1.
• It's also important to identify and avoid potential triggers, such as nickel-containing jewelry or certain hair products, which can exacerbate eczema symptoms 1.
• In cases where eczema is severe or unresponsive to topical treatments, patients may require more potent steroids or alternative medications, such as tacrolimus or pimecrolimus, under the guidance of a healthcare professional 1.
• Regular follow-up and monitoring are necessary to adjust treatment as needed and prevent complications, such as infection or hearing loss.
• Patients should be educated on how to properly care for their ears, including keeping the ear canal dry and avoiding extreme temperatures, to prevent flare-ups and maintain skin health 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). Use ELIDEL Cream only on areas of your skin that have eczema.

The treatment of eczema on the external ear is not explicitly mentioned in the provided drug labels. However, since eczema can occur on various parts of the body, including the external ear, and ELIDEL Cream is used to treat eczema, it may be used on the external ear if prescribed by a doctor.

• Key points to consider:
  • ELIDEL Cream is for use on areas of the skin with eczema.
  • It is essential to follow the doctor's advice and instructions for use.
  • The cream should be applied only to the affected skin areas, as directed by the doctor.
  • If you have any questions or concerns, you should consult your doctor or pharmacist. 2 2

From the Research

Eczema External Ear Treatment

• The treatment of eczema in the external ear involves the use of topical corticosteroids, with the potency and frequency of application depending on the severity of the condition 3.
• A study comparing pimecrolimus 1% and clobetasone butyrate 0.05% for the treatment of eczematous external otitis found that pimecrolimus resulted in a greater and more sustained improvement in symptoms at 12 months 4.
• Topical corticosteroids are classified by strength, with higher potency associated with a greater risk of adverse effects such as skin thinning 5.
• A systematic review and network meta-analysis of randomized trials found that pimecrolimus, tacrolimus, and moderate-potency topical corticosteroids were among the most effective treatments for improving and maintaining control of atopic dermatitis symptoms 6.
• Another systematic review and network meta-analysis found that potent topical steroids, Janus kinase inhibitors, and tacrolimus 0.1% were consistently ranked as among the most effective topical anti-inflammatory treatments for eczema 7.

Treatment Options

• Topical corticosteroids: potent and moderate-potency corticosteroids are probably more effective than mild corticosteroids for treating eczema 3.
• Pimecrolimus: a topical immunomodulator that has been shown to be effective in treating eczematous external otitis and atopic dermatitis 4, 6.
• Tacrolimus: a topical immunomodulator that has been shown to be effective in treating atopic dermatitis and eczema 6, 7.
• Janus kinase inhibitors: a class of medications that have been shown to be effective in treating eczema and atopic dermatitis 6, 7.

Application and Dosage

• Topical corticosteroids can be applied once or twice daily, with the frequency and duration of treatment depending on the severity of the condition and the potency of the corticosteroid 3, 5.
• The quantity of topical corticosteroid prescribed depends on the duration of treatment, the frequency of application, and the surface area of the skin being treated 5.
• Patients can be taught to apply topical corticosteroids using the fingertip unit method, which involves applying a small amount of medication to the affected area 5.