From the Guidelines
Treatment options for psoriasis involving the ears include topical corticosteroids as first-line therapy, with medications like fluocinonide 0.05% or betamethasone valerate 0.1% applied twice daily for 2-4 weeks. For the ear canal, corticosteroid solutions or suspensions such as dexamethasone 0.1% drops are preferred 1. Calcineurin inhibitors like tacrolimus 0.1% ointment or pimecrolimus 1% cream are effective steroid-sparing alternatives, especially for long-term management. For moderate to severe cases, vitamin D analogs such as calcipotriol can be combined with steroids. Careful application is necessary to avoid getting medications deep into the ear canal. Patients should clean the affected areas gently before application and follow up with a healthcare provider if symptoms worsen or don't improve after 2-4 weeks of treatment. These treatments work by reducing inflammation, normalizing skin cell production, and suppressing the overactive immune response that causes psoriasis. For severe or resistant cases, systemic treatments like methotrexate, biologics, or phototherapy may be considered, though these target the whole body rather than just the ears 1.
Some key considerations when treating psoriasis involving the ears include:
- The choice of vehicle can significantly alter the use and penetration of the medication and therefore alter the efficacy 1
- Occlusion of topical medications can also alter the penetration, thereby varying the effectiveness 1
- Combination regimens, utilizing medications from different categories, have been studied and shown to be potentially beneficial 1
- The use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant disease is not routinely recommended 1
It's also important to note that treatment should be tailored to meet individual patients’ needs, taking into account factors such as body location, characteristics of the psoriasis being treated, and patient preferences 1. Additionally, patients with severe or resistant cases may require systemic treatments, which can have significant benefits but also potential risks and side effects 1.
From the Research
Treatment Options for Psoriasis Involving the Ears
- Topical corticosteroids are a common treatment option for psoriasis, including cases involving the ears 2, 3
- Intralesional injection of triamcinolone acetonide can be effective for patients resistant to other therapies 4
- Ultraviolet B phototherapy can be used to treat moderate to severe plaque psoriasis, including cases involving the ears 5, 6
- Combination therapy, such as using topical corticosteroids with ultraviolet phototherapy, can be effective for some patients 5, 6
- Individualized treatment approaches are necessary, taking into account the severity of the disease, patient expectations, and potential triggering factors 2, 3, 6
Specific Treatment Considerations for Ear Psoriasis
- Prevention of further irritation and infection is important, and can be achieved through careful cleansing and avoidance of picking and scratching 4
- Topical immunomodulators may be effective for treating psoriatic lesions on the face and in intertriginous areas, including the ears 2, 3
- Phototherapy, including ultraviolet B phototherapy, can be used to treat psoriasis involving the ears, but requires careful dosing and monitoring to minimize side effects 5, 6