What are the treatment options for psoriasis affecting the ears?

Treatment of Psoriasis Affecting the Ears

For psoriasis affecting the ears, topical corticosteroids are the first-line treatment, with moderately potent (class III) preparations being most appropriate for this sensitive area. 1

First-Line Treatments

• Moderately potent topical corticosteroids (British National Formulary grade III) are recommended for ear psoriasis to relieve symptoms while minimizing side effects 1
• Emollients should be used as adjunctive therapy to reduce itching, scaling, and help maintain skin barrier function 2
• Apply emollients 1-3 times daily to affected areas to improve hydration and reduce symptoms 2

Second-Line Treatments

• Low concentration coal tar preparations (starting with 0.5-1.0% crude coal tar in petroleum jelly) can be used if corticosteroids are ineffective, with concentration gradually increased to a maximum of 10% 1
• Vitamin D analogues (calcipotriene) can be used alone or in combination with corticosteroids for better efficacy 1
• For resistant cases, intralesional injection of triamcinolone acetonide has proven effective 3

Special Considerations for Ear Psoriasis

• The ear is considered a sensitive and vulnerable area, requiring careful selection of treatment options 1
• Avoid high-potency (class I or II) corticosteroids for long-term use in the ear area due to increased risk of skin atrophy 1
• Short-contact therapy approaches may be beneficial to minimize side effects while maintaining efficacy 1
• Careful cleansing and avoidance of picking or scratching are important preventive measures 3

Treatment Algorithm

1. Mild ear psoriasis:

   • Start with moderately potent (class III) topical corticosteroid once daily 1
   • Add emollients 1-3 times daily 2
   • Use for 2-4 weeks, then reassess 1

2. If inadequate response:

   • Consider combination therapy with vitamin D analogue (morning) and corticosteroid (evening) 1
   • Or try low concentration coal tar preparations 1

3. For resistant cases:

   • Consider intralesional triamcinolone acetonide injection 3
   • Evaluate for more extensive disease requiring systemic therapy if ear psoriasis is part of widespread involvement 1

Monitoring and Precautions

• Regular clinical review is essential when using topical corticosteroids 1
• No unsupervised repeat prescriptions should be provided 1
• Periods where alternative treatments are employed should be incorporated into the treatment plan 1
• For patients with more than 5% body surface area affected or with significant quality of life impact, consider systemic therapy 1

Treatment in Special Populations

• For pregnant patients, emollients are considered safe and should be first-line treatment 2
• For children, use lower potency corticosteroids and monitor closely for side effects 4

Remember that while ear psoriasis may seem localized, it can significantly impact quality of life and may be part of more widespread disease requiring comprehensive assessment and management 1.