What is the treatment for ear eczema?

From the Guidelines

Treatment for ear eczema typically involves a combination of gentle skin care, topical medications, and trigger avoidance, with topical corticosteroids like hydrocortisone 1% cream or fluticasone 0.05% cream being first-line treatments. When managing ear eczema, it's essential to keep the affected area clean using mild, fragrance-free cleansers and warm (not hot) water. Topical corticosteroids should be applied thinly to affected areas twice daily for 7-14 days 1. For more severe cases, medium-potency steroids like triamcinolone 0.1% may be needed.

Key Considerations

• Topical calcineurin inhibitors such as tacrolimus 0.1% ointment or pimecrolimus 1% cream are steroid-free alternatives, especially useful for sensitive areas or long-term management 1.
• Moisturize regularly with petroleum jelly or ceramide-containing moisturizers to maintain the skin barrier.
• Antihistamines like cetirizine 10mg daily can help control itching.
• Avoid known triggers such as nickel earrings, hair products, and harsh soaps.
• If the ear canal is involved, prescription ear drops containing corticosteroids may be necessary.
• Persistent or severe cases may require oral corticosteroids or immunosuppressants prescribed by a dermatologist. It's also important to note that the use of topical corticosteroids should be explained to patients, including the benefits and risks, as outlined in previous guidelines 1. However, the most recent and highest quality study 1 provides the best guidance for current treatment practices.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). The treatment for ear eczema is not directly addressed in the provided drug labels. Key points:

• ELIDEL Cream is used to treat eczema (atopic dermatitis) on the skin.
• There is no specific information on treating ear eczema. 2 2

From the Research

Treatment Options for Ear Eczema

• Topical corticosteroids are a common treatment for eczema, including ear eczema, with potent and moderate topical corticosteroids being more effective than mild ones 3
• Pimecrolimus cream 1% has been shown to effectively control atopic eczema, including in delicate body regions such as the face, and may be suitable for ear eczema due to its low percutaneous absorption 4, 5
• Tacrolimus is another treatment option for atopic dermatitis, with studies showing significant improvement in disease severity over a 12-week treatment period 6

Application and Duration

• Applying potent topical corticosteroids once a day may be as effective as twice daily application in treating eczema flare-ups 3
• Proactive treatment with topical corticosteroids, such as applying them twice weekly, may help prevent relapses 3
• The optimal duration of treatment for a flare-up is not well established, and more research is needed in this area 3

Safety and Efficacy

• Pimecrolimus has a favorable safety profile, with low percutaneous absorption and minimal risk of systemic side effects 5
• Topical corticosteroids can have local adverse effects, such as skin thinning, especially with long-term use of higher-potency preparations 3
• Tacrolimus can cause a burning sensation in some patients, but is generally well-tolerated 6