What is the treatment for eczema (atopic dermatitis) of the ear?

From the Guidelines

To treat ear eczema, start with gentle cleansing using warm water and a mild, fragrance-free soap, followed by thorough drying, and apply a topical corticosteroid cream such as hydrocortisone 1% or triamcinolone 0.1% to inflamed areas twice daily for 7-10 days, as recommended by the most recent guidelines 1. The treatment of ear eczema involves a multi-faceted approach that includes gentle skin care, application of emollients, prevention of secondary skin infection, and the use of topical corticosteroids and other antipruritics. Key aspects of treatment include:

• Gentle cleansing with a mild soap
• Application of topical corticosteroids such as hydrocortisone 1% or triamcinolone 0.1% to inflamed areas
• Regular moisturizing with petroleum jelly or a fragrance-free emollient to maintain the skin barrier
• Avoidance of known triggers like nickel earrings, harsh soaps, and hair products that contact the ears
• Use of antihistamines like cetirizine 10mg daily if itching is severe It is essential to note that the management of ear eczema should prioritize the use of the least potent preparation required to keep the eczema under control, and when possible, corticosteroids should be stopped for short periods, as suggested by earlier guidelines 1. Additionally, avoiding provoking factors such as soaps and detergents, extremes of temperature, and irritant clothing is crucial in managing ear eczema, as emphasized in previous studies 1. In cases where ear eczema is refractory to treatment, it is essential to consider alternative causes of ear pain and associated otorrhea, including fungal infections, resistant bacteria, or unusual causes of infection that require targeted topical or systemic therapy, as discussed in recent clinical practice guidelines 1.

From the Research

Treatment for Eczema (Atopic Dermatitis) of the Ear

The treatment for eczema (atopic dermatitis) of the ear typically involves topical anti-inflammatory treatments, such as topical corticosteroids and calcineurin inhibitors 2.

• Topical Corticosteroids: Potent and very potent topical corticosteroids are often used to treat eczema, including eczema of the ear 3, 4.
• Calcineurin Inhibitors: Tacrolimus 0.1% and pimecrolimus 1% are examples of calcineurin inhibitors that can be used to treat eczema of the ear 3, 2.
• Other Treatments: Other treatments, such as emollients, wet wrap therapy, and antihistamines, may also be used to help manage eczema symptoms 2, 5.
• Local Adverse Effects: Local adverse effects, such as application-site reactions and skin thinning, can occur with topical treatments, especially with long-term use 3, 6.
• Treatment Duration: The duration of treatment for eczema of the ear can vary, but intermittent use of topical corticosteroids for up to 5 years has been shown to be safe and effective 6.

Efficacy of Topical Treatments

The efficacy of topical treatments for eczema of the ear can vary, but potent and very potent topical corticosteroids, as well as tacrolimus 0.1%, have been shown to be effective in reducing symptoms 3, 4.

• Network Meta-Analysis: A network meta-analysis of 291 trials found that potent and very potent topical corticosteroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 3, 4.
• Investigator Global Assessment: The Janus kinase inhibitors ruxolitinib 1.5%, delgocitinib 0.5% or 0.25%, very potent/potent topical corticosteroids, and tacrolimus 0.1% were ranked as most effective for investigator global assessment 3, 4.