From the Guidelines
Treatment for ear canal eczema typically involves topical corticosteroids like hydrocortisone 1% or fluocinolone 0.025% ear drops, applied 2-3 times daily for 7-10 days to reduce inflammation and itching. According to the clinical practice guideline for acute otitis externa 1, management of eczema in the ear canal includes gentle skin care, application of emollients, prevention of secondary skin infection, and the use of topical corticosteroids and other antipruritics. It is essential to identify and avoid triggers that may cause allergic reactions, such as hair products, earphones, or metal jewelry.
For severe cases, a physician may prescribe stronger steroids or add antibiotic drops if infection is present 1. Keeping the ears dry during treatment by avoiding swimming and using earplugs when showering is also crucial. Gently cleaning the external ear with a damp cloth, while avoiding inserting anything into the ear canal, can help prevent further irritation. Long-term management includes using hypoallergenic products and applying moisturizers like petroleum jelly around (but not in) the ear canal to maintain skin barrier function.
It is also important to note that contact dermatitis of the ear canal can be caused by various substances, including neomycin, which is commonly found in otic preparations 1. If symptoms persist beyond two weeks of treatment or if there's severe pain, discharge, or hearing loss, it is essential to consult a healthcare provider as these may indicate complications requiring different management.
From the Research
Treatment Options for Ear Canal Eczema
- Topical corticosteroids are a common treatment for ear canal eczema, with stronger potencies (e.g., potent, very potent) being more effective than weaker potencies (e.g., mild, moderate) 2
- Applying topical corticosteroids once a day is probably as effective as applying them twice a day or more 2
- Topical pimecrolimus has been shown to be effective in treating external auditory canal pruritus, with a decrease in itching scores of 52.3% by the third week and 77.6% by the third month 3
- Hydrocortisone preparations have also been used to treat ear canal eczema, with some studies showing good to excellent results in a few days 4
Avoiding Irritants and Triggers
- Identifying and avoiding irritants or allergens that may be causing the eczema is crucial, such as rubber earplugs 5
- Avoiding water, cosmetics, and other materials that may exacerbate the condition is also important 6
Other Treatments
- A suspension of human cerumen in glycerine has been used to treat seborrheic dermatitis of the ear canal, with instructions to place two drops in the external ear canal once a week 6
- Massaging the ear canal with a cotton tip applicator soaked with a hydrocortisone preparation has also been shown to be effective in treating itching and oozing in the ear canal 4