From the Guidelines
For outer ear canal psoriasis, topical corticosteroids are typically the first-line treatment, with fluocinonide 0.05% solution or betamethasone valerate 0.1% solution applied twice daily for 1-2 weeks often effective for controlling inflammation and scaling. The choice of vehicle can significantly alter the use and penetration of the medication, and different vehicles are indicated for different body sites 1. For maintenance therapy, a less potent steroid like hydrocortisone 1% can be used. Calcipotriol (a vitamin D analog) may be added as a steroid-sparing agent, applied once daily 1. If there's significant buildup of scales, gentle cleaning with mineral oil followed by careful removal of debris may be recommended. For cases resistant to topical steroids, tacrolimus 0.1% ointment or pimecrolimus 1% cream can be effective alternatives without the risk of skin thinning that comes with long-term steroid use 1.
Some key considerations in treating outer ear canal psoriasis include:
- Keeping the ear canal dry and avoiding scratching or inserting objects into the ear to prevent worsening symptoms and potential infection.
- Using topical corticosteroids with caution and under medical guidance to avoid side effects such as skin thinning.
- Considering the use of vitamin D analogs like calcipotriol as steroid-sparing agents to reduce the risk of adverse effects.
- Being aware of the potential for contact dermatitis or allergic reactions to topical agents, and managing these conditions appropriately with removal of the sensitizing agent and application of topical steroids or other anti-inflammatory agents 1.
Overall, the goal of treatment for outer ear canal psoriasis is to control symptoms, reduce inflammation, and improve quality of life while minimizing the risk of adverse effects. The most recent and highest quality evidence supports the use of topical corticosteroids as the first-line treatment, with adjunctive therapies used as needed to manage resistant cases or reduce the risk of side effects 1.
From the Research
Treatment Options for Outer Ear Canal Psoriasis
- Topical therapies are the mainstay for the majority of patients who have limited or mild psoriasis, including those with outer ear canal psoriasis 2.
- Topical vitamin D analogs (eg, calcipotriene) and corticosteroids (eg, betamethasone), and these drugs in combination, are the most widely prescribed psoriasis drugs and are the cornerstone of topical therapies 2.
- For patients with outer ear canal psoriasis, mild disease may be treated with a wide array of topical agents including corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound 3.
Recommended Topical Therapies
- The combination of potent and superpotent corticosteroids with vitamin D analogues provides an improvement of psoriasis within 2 weeks, reaching a maximal improvement after 4 weeks in the majority of patients 4.
- The two-compound product (calcipotriene and betamethasone) permits once-daily treatment and therefore is a good solution for chronic plaque psoriasis, including scalp psoriasis, and may also be effective for outer ear canal psoriasis 4, 5.
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis, and are available in formulations such as ointments, creams, lotions, gels, foams, oils, solutions, and shampoos 6.
Application and Usage
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 6.
- Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 6.
- The application of two-compound-products once or twice a week after initial therapy is recommended due to a favorable risk-benefit ratio in maintenance trials and due to better cost-effectiveness 5.