From the Guidelines
For treating ear canal psoriasis, a high-potency topical steroid such as clobetasol propionate 0.05% solution is the most effective option, as evidenced by its high efficacy rates of 58%-92% 1. This recommendation is based on the guidelines of care for the management of psoriasis and psoriatic arthritis, which suggest that topical agents are the primary treatment for mild to moderate psoriasis, and that the choice of vehicle can significantly alter the use and penetration of the medication 1. Some key points to consider when using topical steroids for ear canal psoriasis include:
- The solution formulation is preferred over cream or ointment to ensure proper penetration into the ear canal
- The medication should be applied as 2-3 drops into the affected ear canal twice daily for 1-2 weeks, then tapered to once daily for another week before discontinuing
- It's essential to clean the ear canal gently with a cotton swab before instilling the drops and to remain in the same position for 1-2 minutes to allow absorption
- High-potency steroids work by reducing inflammation, suppressing immune responses, and decreasing cell proliferation that causes the characteristic scaling and thickening of psoriatic skin
- If the condition extends to the outer ear, the same medication may need to be applied to those areas as well
- Discontinue use and consult a physician if increased pain, discharge, or hearing changes occur, as secondary infection can occur
- For maintenance therapy after the initial treatment period, consider switching to a medium-potency steroid like triamcinolone 0.1% solution to prevent skin atrophy with long-term use.
From the Research
Topical Steroids for Ear Canal Psoriasis
There are limited studies specifically focusing on the best topical steroid for treating ear canal psoriasis. However, some evidence can be drawn from studies on psoriasis treatment in general and other skin conditions affecting the ear canal.
- The study 2 discusses the treatment of erythematous-squamous disorders of the external auditory canal, including psoriasis, with tacrolimus and clotrimazole in otic oil, showing significant improvement in patients.
- For psoriasis treatment in other areas, topical corticosteroids are a common choice, as mentioned in 3 and 4. These studies highlight the effectiveness of corticosteroids but also note the importance of individualized treatment approaches.
- Specific topical corticosteroids like hydrocortisone 17-butyrate have been studied for their efficacy in psoriasis and other dermatoses, as seen in 5, which might be relevant for ear canal psoriasis due to their potency and potential for less severe side effects compared to other corticosteroids.
Considerations for Treatment
When considering treatment for ear canal psoriasis:
- The anatomy of the ear canal and the potential for side effects from topical treatments should be taken into account.
- The choice of topical steroid should balance efficacy with the risk of side effects, such as skin atrophy or adrenal suppression, as discussed in 5.
- Combination therapies, like those mentioned in 4 for scalp psoriasis, might also be considered for ear canal psoriasis, adapting the treatment to the specific needs and responses of the patient.