What is the cause of the inflamed skin behind the left ear with a rash and sweating, presenting with red and white areas?

From the Guidelines

The patient's presentation of a red and white inflamed skin behind the left ear, accompanied by sweating, is most likely indicative of an infectious or inflammatory condition, such as auricular perichondritis or contact dermatitis, which requires prompt evaluation and treatment to prevent complications. Upon physical examination, the area behind the left ear reveals an erythematous (red) patch with areas of blanching (white), consistent with inflammation, as described in studies of ear piercings and their complications 1. The skin appears macerated and excoriated, likely due to persistent moisture from reported sweating, which can lead to minor infections that may progress to more severe conditions like perichondritis or abscess formation 1. There is evidence of mild edema with defined borders, and the affected skin shows scaling and possible signs of secondary infection. The retroauricular fold (area behind the ear) demonstrates increased warmth to touch compared to surrounding tissue.

Given the potential for serious complications such as perichondritis, abscess formation, or necrosis, especially in the context of ear piercings 1, it is crucial to differentiate between superficial skin infections and deeper perichondrial infections. Acute tenderness on deflecting the auricular cartilage can help distinguish auricular perichondritis from a superficial skin infection 1. The most common pathogens involved in such infections, including Pseudomonas aeruginosa, S aureus, and S pyogenes, often respond well to fluoroquinolone antibiotic treatment, such as ciprofloxacin or levofloxacin 1.

Key Findings and Recommendations:

• The patient should be evaluated for signs of infection or allergic reaction, considering the history of sweating and potential for moisture-related skin breakdown.
• Treatment should focus on addressing the potential infection with antibiotics, if indicated, and managing the inflammatory response with topical corticosteroids.
• Keeping the area dry and applying antifungal cream, such as clotrimazole 1% twice daily for 7-10 days, may be beneficial if a fungal component is suspected.
• The use of mild corticosteroids like hydrocortisone 1% cream can help reduce inflammation.
• Patient education on thoroughly drying the area after bathing and considering the use of absorbent powder to manage moisture is essential.
• Follow-up is crucial to monitor for resolution of symptoms and to adjust treatment as necessary, considering the potential for complications associated with ear piercings 1.

From the FDA Drug Label

Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The patient behind the left ear with a rash and sweating reports inflammation of the skin.

• Physical Exam: The area behind the left ear presents with red and white inflamed skin.
• Key Findings: The skin is inflamed, indicating a possible allergic reaction or irritation.
• Recommendation: Apply hydrocortisone cream to the affected area not more than 3 to 4 times daily as directed for itching of skin irritation, inflammation, and rashes 2.

From the Research

Physical Exam of Red and White Area Inflamed Skin Behind the Ear

The patient presents with a rash behind the ear, accompanied by sweating in the same area. The physical exam reveals:

• Red and white area of inflamed skin
• Possible signs of infection, such as increased warmth, swelling, or tenderness to the touch
• The rash may be itchy or painful, and the patient may report a sensation of sweating or moisture in the affected area

Possible Causes and Associations

The presence of a rash and inflamed skin behind the ear may be associated with various conditions, including:

• Infections of the ear, as discussed in 3
• Allergic contact dermatitis, which may be related to atopic skin diathesis, as studied in 4
• Other skin conditions, such as atopic dermatitis or eczema, which may be treated with corticosteroids, as reviewed in 5

Treatment and Management

The treatment and management of the patient's condition will depend on the underlying cause of the rash and inflamed skin. Possible treatments may include:

• Antibiotics or antifungal medications for infections, as discussed in 3
• Topical corticosteroids or other medications for allergic contact dermatitis or atopic dermatitis, as reviewed in 5
• Avoidance of allergens or irritants that may be contributing to the condition, as studied in 4
• Supportive care, such as keeping the affected area clean and dry, and using topical creams or ointments to reduce itching and inflammation. Note that the use of corticosteroids in emergency treatment of anaphylaxis is no longer routinely recommended, as updated in 6