From the Guidelines
For fungal infections behind the ear, over-the-counter antifungal creams containing clotrimazole 1% or miconazole 2% are typically effective, while for eczema, hydrocortisone 1% cream is recommended, emphasizing the importance of correct diagnosis to avoid worsening fungal infections with corticosteroids 1. When considering the treatment for fungal vs eczema conditions on the back of the ear, it's essential to differentiate between the two due to their distinct treatment approaches.
Key Considerations
- Fungal infections typically present as red, scaly patches with defined borders and possible itching, and can be treated with antifungal creams.
- Eczema presents as red, inflamed skin that may be dry, cracked, and intensely itchy, and its treatment involves the use of topical corticosteroids or other anti-inflammatory medications.
Treatment Approaches
- For fungal infections, apply a thin layer of antifungal cream to the affected area twice daily for 2-4 weeks, continuing for at least one week after symptoms resolve to prevent recurrence.
- For eczema, apply hydrocortisone 1% cream thinly twice daily for up to 7 days; for more severe cases, prescription-strength corticosteroids or non-steroidal options like tacrolimus or pimecrolimus may be necessary.
Importance of Diagnosis
- Correct diagnosis is crucial before initiating treatment, as using corticosteroids on fungal infections can exacerbate them.
- If symptoms do not improve within two weeks of treatment, or if there's severe pain, spreading infection, or discharge, consult a healthcare provider for proper diagnosis and treatment, as indicated by the clinical practice guideline on acute otitis externa 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema The best cream to apply for eczema on the back of the ear is hydrocortisone (TOP), as it temporarily relieves itching associated with eczema.
- For fungal conditions, the FDA drug label does not answer the question. 2
From the Research
Fungal Infections
- For fungal infections, studies suggest that naftifine and clotrimazole are effective treatments 3.
- Naftifine has anti-inflammatory properties, making it a suitable option for fungal infections with inflammatory components 3.
- Clotrimazole is also effective, but it may contain allergenic ingredients like propylene glycol, which can cause allergic contact dermatitis 4.
Eczema
- For eczema, topical corticosteroids are a common treatment option 5, 6, 7.
- Hydrocortisone buteprate 0.1% cream has been shown to be effective and safe in treating atopic dermatitis, with significant improvement in dermatitis signs and overall improvement compared to placebo 7.
- Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 6.
- Twice weekly application of topical corticosteroids (proactive therapy) can help prevent eczema relapse (flare-ups) 6.
Comparison of Treatments
- When choosing a cream for the back of the ear, it's essential to consider the specific condition (fungal or eczema) and the potential for allergenic ingredients in antifungal creams 4.
- Terbinafine hydrochloride 1% and clotrimazole 1% contain the least number of potential allergenic ingredients among common antifungal creams 4.
- Hydrocortisone buteprate 0.1% cream is a suitable option for eczema, with a good safety profile and cosmetic acceptability 7.