What is the treatment for external ear canal eczema (also known as otitis externa eczematosa)?

From the Guidelines

The treatment for external ear canal eczema (otitis externa eczematosa) primarily involves the use of topical corticosteroids and gentle skin care to reduce inflammation and prevent secondary skin infections, as recommended by the clinical practice guideline for acute otitis externa 1. The management of ear canal eczema includes:

• Gentle skin care
• Application of emollients
• Prevention of secondary skin infection
• Use of topical corticosteroids and other antipruritics, such as those mentioned in the guideline 1 It is essential to note that contact dermatitis of the ear canal, which can be irritant or allergic, should be considered in the differential diagnosis, and management involves removing the sensitizing agent and applying a topical steroid or other anti-inflammatory topical, as discussed in the guideline 1. Key aspects of treatment include:
• Topical corticosteroids to reduce inflammation and itching
• Gentle ear care to prevent further irritation
• Avoidance of inserting objects into the ear canal to prevent micro-abrasions and removal of protective ear wax
• Consideration of oral antihistamines for severe itching, although this is not explicitly mentioned in the provided guideline, it is a common practice in managing pruritus associated with eczema. The goal of treatment is to reduce inflammation, prevent infection, and alleviate symptoms, thereby improving the quality of life for patients with external ear canal eczema, as the primary concern is to minimize morbidity and mortality associated with the condition, and the guideline provides the most recent and relevant evidence for this purpose 1.

From the Research

Treatment for External Ear Canal Eczema

The treatment for external ear canal eczema, also known as otitis externa eczematosa, involves various approaches.

• Topical treatment is the first-line treatment for inflammation of the external auditory canal, including eczematous otitis externa, without the need for systemic antimicrobial drug therapy 2.
• The ear canal should be cleaned mechanically, by rinsing with saline, and finally dried by suction before applying topical treatment 2.
• A combinatorial broad-spectrum antibiotic/corticosteroid ear drop is an effective remedy for bacterial inflammation, whereas cleaning and topical medication are crucial in fungal infections 2.
• Topical antimicrobials containing steroids are significantly more effective than placebo drops in treating acute otitis externa, which may include eczematous otitis externa 3.
• Pimecrolimus 1% cream has been shown to be an effective alternative therapeutic agent for the treatment of external ear atopic dermatitis, which can be related to eczematous otitis externa 4.
• Tacrolimus 0.1% and clotrimazole 1% in otic oil have been used successfully to treat erythematous-squamous disorders of the external auditory canal, including seborrheic dermatitis, psoriasis, and allergic contact dermatitis 5.
• Budesonide has been found to be clinically effective in the treatment of eczematous external otitis, reducing the severity of symptoms and improving erythema, swelling, and discharge 6.

Key Considerations

• The choice of topical intervention may not significantly influence the therapeutic outcome, and other factors such as risk of ototoxicity, risk of contact sensitivity, and cost should be considered 3.
• Patient symptoms and satisfaction should be closely monitored, and treatment should be adjusted accordingly 3, 5.
• Mechanical cleaning of the ear canal is an essential step in the treatment of external ear canal eczema 2, 6.