What are the recommended ear drops for treating psoriasis in the ear?

Treatment of Psoriasis in the Ear

For psoriasis affecting the ear, use moderately potent (class III) topical corticosteroids as first-line therapy, combined with regular emollient application, avoiding high-potency steroids due to the risk of skin atrophy in this sensitive area. 1

First-Line Treatment Approach

• Apply moderately potent topical corticosteroids (class III) once daily to affected ear areas for 2-4 weeks, then reassess response 1
• Add emollients 1-3 times daily to all affected areas to reduce itching, scaling, and maintain skin barrier function 1
• The ear is a vulnerable area requiring careful treatment selection to minimize adverse effects while maintaining efficacy 1

Critical Safety Consideration

• Avoid high-potency (class I or II) corticosteroids for long-term use in the ear due to significantly increased risk of skin atrophy in this thin-skinned area 1
• Regular clinical review is essential when using topical corticosteroids, with no unsupervised repeat prescriptions 1

Second-Line Options for Inadequate Response

If initial therapy fails after 2-4 weeks:

• Combination therapy with vitamin D analogue (calcipotriene) in the morning and corticosteroid in the evening provides superior efficacy to either agent alone 1, 2
• Low concentration coal tar preparations starting with 0.5-1.0% crude coal tar in petroleum jelly, gradually increasing to maximum 10% if needed 1
• Short-contact therapy approaches may minimize side effects while maintaining efficacy 1

Treatment Algorithm

1. Initial 2-4 weeks: Moderately potent topical corticosteroid once daily + emollients 1-3 times daily 1
2. If inadequate response: Add calcipotriene (morning application) while continuing corticosteroid (evening application) 1
3. If still inadequate: Consider low concentration coal tar preparations as alternative 1
4. Incorporate treatment-free periods where alternative treatments are employed to reduce long-term corticosteroid exposure 1

When to Consider Systemic Therapy

• If more than 5% body surface area is affected or there is significant quality of life impact, systemic therapy should be considered 1
• Ear psoriasis may be part of more widespread disease requiring comprehensive assessment 1

Common Pitfalls to Avoid

• Do not use ear drops formulated for acute otitis externa (which contain antibiotics and antiseptics) for psoriasis, as these are designed for bacterial infections, not inflammatory dermatoses 2
• Do not confuse psoriasis with other dermatoses such as eczema or seborrheic dermatitis, which can mimic psoriasis but require different management approaches 2
• Avoid prolonged continuous use of topical corticosteroids without incorporating treatment breaks or alternative therapies 1, 3

Special Populations

• For pregnant patients: Emollients are considered safe and should be first-line treatment 1
• For pediatric patients: The same principles apply, though smaller volumes may be sufficient 4