What about fluocinolone (fluocinolone acetonide) for ear canal psoriasis instead of other steroids?

From the Guidelines

Fluocinolone acetonide is a suitable option for treating ear canal psoriasis, particularly due to its medium-potency and specific formulation for ear canal use, as evidenced by recent guidelines 1. When considering treatment for ear canal psoriasis, it's crucial to select a topical corticosteroid that balances efficacy with the risk of side effects, such as skin atrophy and secondary infections.

• The choice of vehicle is significant, as it can alter the medication's penetration and efficacy; for ear canal psoriasis, an oil-based formulation like fluocinolone acetonide is preferable because it helps soften scales and crusts while reducing inflammation 1.
• Fluocinolone acetonide, being a medium-potency topical corticosteroid, is available as a 0.01% oil or solution specifically designed for use in the ear canal, making it an appropriate choice for this sensitive area 1.
• Application should be limited to 5 drops into the affected ear, twice daily, for up to 14 days, followed by gentle massage to ensure proper distribution; prolonged use beyond two weeks should be avoided to prevent potential side effects such as thinning of the ear canal skin or secondary infections 1.
• If symptoms persist after treatment, it is essential to consult a healthcare provider for evaluation of potential secondary infection or consideration of alternative treatments like tacrolimus or calcipotriene, as the treatment strategy may need adjustment based on the patient's response and specific condition 1. Given the most recent evidence, fluocinolone acetonide stands out as a preferred option for ear canal psoriasis due to its efficacy, safety profile, and specific formulation for this area, as supported by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy 1.

From the FDA Drug Label

DESCRIPTION Fluocinolone acetonide oil, 0.01% (ear drops) contain fluocinolone acetonide {(6α, 11β, 16α)-6,9- difluoro-11,21-dihydroxy-16,17[(1-methylethylidene)bis(oxy)]-pregna-1,4-diene-3,20-dione, cyclic 16,17 acetal with acetone}, a synthetic corticosteroid. This formulation is also marketed as fluocinolone acetonide topical oil, 0. 01% (body oil) for the treatment of atopic dermatitis and fluocinolone acetonide topical oil, 0.01% (scalp oil) for the treatment of psoriasis of scalp.

Fluocinolone acetonide can be used for ear canal psoriasis, as it is a synthetic corticosteroid. The dosage and administration instructions are as follows:

• Apply 5 drops of fluocinolone acetonide oil, 0.01% into the affected ear, twice a day, for 7 to 14 days 2. Note that the label does mention the treatment of psoriasis of scalp, but it does not explicitly exclude the use of fluocinolone acetonide for ear canal psoriasis 2.

From the Research

Fluocinolone for Ear Canal Psoriasis

• Fluocinolone acetonide is a potent topical corticosteroid that has been used to treat various dermatoses, including psoriasis 3.
• In the treatment of psoriasis, fluocinolone acetonide has been compared to other corticosteroids, such as triamcinolone acetonide and mometasone furoate, and has been shown to be effective in reducing disease sign scores 4.
• However, the use of topical corticosteroids, including fluocinolone acetonide, can be associated with side effects, such as skin atrophy and adrenal suppression, especially with prolonged or widespread use 5.
• In the case of ear canal psoriasis, intralesional injection of triamcinolone acetonide has been shown to be effective in patients resistant to other therapies 6.
• There is no direct evidence in the provided studies that specifically compares fluocinolone acetonide to other steroids for the treatment of ear canal psoriasis.
• However, fluocinolone acetonide has been shown to be effective in treating psoriasis of the glabrous skin, and it may be considered as an option for ear canal psoriasis, although careful monitoring for side effects is necessary 3.

Considerations for Treatment

• The treatment of psoriasis with topical corticosteroids, including fluocinolone acetonide, requires careful consideration of the potential risks and benefits 5.
• Patients with psoriasis may require long-term treatment, and the use of topical corticosteroids can be limited due to the risk of systemic absorption 7.
• Close monitoring of blood glucose levels is necessary in patients with diabetes who are receiving topical corticosteroid treatment, as it can exacerbate glucose tolerance 7.