What is the treatment for psoriasis (psoriasis) affecting the ears?

Treatment of Psoriasis Affecting the Ears

For ear psoriasis, apply low-potency topical corticosteroids (such as 1% hydrocortisone) or calcipotriene combined with hydrocortisone for 8 weeks as first-line therapy, reserving intralesional triamcinolone acetonide injections for thick, treatment-resistant lesions. 1, 2, 3

Initial Topical Treatment Approach

The ears represent a challenging anatomic location requiring careful corticosteroid selection to avoid atrophy and telangiectasia. 1, 2

• Start with low-potency corticosteroids (1% hydrocortisone) or calcipotriene combined with hydrocortisone applied for 8 weeks as the preferred initial therapy for ear psoriasis 2
• This combination provides efficacy while minimizing corticosteroid exposure in this vulnerable area 2
• Apply twice daily to affected areas, rubbing in gently 1
• Maximum continuous treatment duration with low-potency corticosteroids is 4 weeks before transitioning to maintenance therapy 2

Critical safety consideration: Never use high-potency (class 1-3) or ultrahigh-potency corticosteroids on the ears, as this dramatically increases the risk of irreversible skin atrophy and telangiectasia. 1, 2 The thin skin of the ear is at particularly high risk for these adverse effects. 1

Alternative First-Line Options

• Tacrolimus (topical calcineurin inhibitor) is an excellent corticosteroid-sparing option for ear psoriasis, as it does not cause skin atrophy and is specifically recommended for facial and intertriginous areas 1, 2
• Calcitriol ointment (vitamin D analogue) can be used to avoid corticosteroid-related atrophy 2
• These agents are particularly valuable for patients requiring treatment beyond 4 weeks 1

Treatment-Resistant Ear Psoriasis

For localized, thick, or treatment-resistant ear lesions that fail to respond to topical therapy:

• Intralesional triamcinolone acetonide injection is highly effective for resistant ear psoriasis 1, 3
• Use triamcinolone acetonide at doses up to 20 mg/mL, injected every 3-4 weeks 1
• Injection volume varies based on lesional size and affected area 1
• This approach is specifically documented as effective for ear psoriasis resistant to other therapies 3

Maintenance Strategy After Initial Control

Once initial control is achieved with low-potency corticosteroids:

• Transition to weekend-only corticosteroid application with weekday vitamin D analogue therapy to minimize corticosteroid exposure while maintaining efficacy 4, 2
• Apply high-potency topical corticosteroid twice daily on weekends only, and vitamin D analogue twice daily on weekdays 4
• This intermittent regimen reduces the risk of skin atrophy while prolonging remission 4

Prevention and Patient Education

• Counsel patients to avoid picking and scratching the ears, as mechanical trauma is a significant trigger for ear psoriasis 3
• Emphasize careful cleansing without aggressive rubbing 3
• These preventive measures are essential, as approximately 18% of all psoriasis patients develop ear involvement at some point 3

Critical Pitfalls to Avoid

• Do not combine salicylic acid with calcipotriene simultaneously—the acidic pH inactivates calcipotriene and eliminates its effectiveness 1, 4, 5
• Do not prescribe unsupervised repeat prescriptions of any topical corticosteroid for ear use without regular clinical review 2
• Avoid abrupt withdrawal of topical corticosteroids, as rebound can occur (though frequency is variable) 1
• Do not use occlusive dressings on the ears, as this increases penetration and atrophy risk 6

When to Escalate Treatment

If ear psoriasis is part of moderate-to-severe disease (>5% body surface area, symptomatic, or inadequate response to localized therapy after 8 weeks), consider systemic therapy or phototherapy rather than intensifying topical treatment on the ears. 4, 5