What is the treatment for otic eczema using steroid drops (topical corticosteroids)?

From the Guidelines

Steroid drops can be used for ear eczema, but they should be prescribed by a healthcare provider, typically a moderate-potency steroid such as fluocinolone acetonide 0.01% (Flucort) or hydrocortisone 1% solution, as recommended by the clinical practice guideline: acute otitis externa 1.

Key Considerations

• The management of ear eczema involves gentle skin care, application of emollients, prevention of secondary skin infection, and the use of topical corticosteroids and other antipruritics, as outlined in the clinical practice guideline: acute otitis externa 1.
• Topical corticosteroids, such as fluocinolone acetonide 0.01% (Flucort) or hydrocortisone 1% solution, can be effective in reducing inflammation, itching, and irritation associated with eczema by suppressing the immune response in the skin.
• The use of steroid drops should be limited to 7-10 days to avoid prolonged use, which can lead to thinning of the skin or secondary infections, as cautioned in the management of atopic eczema guidelines 1.

Application and Precautions

• Before applying steroid drops, gently clean the ear with a warm, damp cloth to remove any debris or discharge.
• If the eardrum is intact, tilt your head to the side and pull the outer ear gently upward and backward to straighten the ear canal before instilling drops.
• Keep your head tilted for 1-2 minutes to allow the medication to penetrate.
• If symptoms persist beyond 10 days or worsen, seek medical attention for reevaluation, as recommended in the clinical practice guideline: acute otitis externa 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY: The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. In pharmacologic doses, corticosteroids are used primarily for their anti-inflammatory and/or immunosuppressive effects Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions. INDICATIONS AND USAGE: Clobetasol propionate topical solution USP, 0.05% is indicated for short-term topical treatment of inflammatory and pruritic manifestations of moderate to severe corticosteroid-responsive dermatoses of the scalp.

The clobetasol propionate otic solution can be used to treat ear eczema due to its anti-inflammatory and antipruritic properties. However, it is essential to note that the provided drug labels do not explicitly mention the use of clobetasol propionate for ear eczema, but rather for scalp psoriasis and other corticosteroid-responsive dermatoses.

• The labels recommend short-term use and advise against treatment beyond 2 consecutive weeks due to the potential for HPA axis suppression 2 2.
• It is crucial to follow the recommended dosage and administration guidelines to minimize potential side effects.
• Pediatric patients under 12 years of age should not use this product 2.

From the Research

Steroid Drops for Ear Eczema

• The use of steroid drops for ear eczema has been studied in various clinical trials 3, 4, 5.
• A study published in 1979 found that clobetasol propionate ear drops were effective in relieving symptoms of otitis externa, with significant improvement in patients within seven days 4.
• Another study published in 2022 compared the long-term response to pimecrolimus and clobetasone butyrate in patients with eczematous external otitis, finding a highly statistically significant difference in favor of pimecrolimus at 12 months 5.
• Topical corticosteroids, such as clobetasone butyrate, are commonly used to treat eczematous external otitis, with studies showing their effectiveness in reducing symptoms and improving quality of life 3, 5.
• The combination of topical antibiotic and steroid drops has also been studied, with some research suggesting that adding an oral antibiotic may not provide significant benefits in uncomplicated cases of acute otitis externa 6.
• However, a study published in 2024 found that oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in resolving symptoms and shortening the duration of ear discharge in children with acute otitis media and ear discharge 7.

Treatment Options

• Topical corticosteroids, such as clobetasol propionate and clobetasone butyrate, are available for the treatment of ear eczema 3, 4, 5.
• Antibiotic-corticosteroid eardrops, such as hydrocortisone-bacitracin-colistin, are also an option for treating ear infections and eczema 7.
• The choice of treatment depends on the severity and cause of the ear eczema, as well as the patient's medical history and other factors 3, 6.

Efficacy and Safety

• The efficacy and safety of steroid drops for ear eczema have been evaluated in several studies, with most showing significant improvement in symptoms and quality of life 3, 4, 5.
• However, the use of steroid drops can also have potential side effects, such as skin thinning and increased risk of infection 3.
• The safety and efficacy of combination treatments, such as topical antibiotic and steroid drops, have also been studied, with some research suggesting that they can be effective in treating ear eczema and infections 6, 7.