How can ear psoriasis be treated and relieved?

Psoriasis, a skin condition often associated with red patches covered with white scales resembling dandruff, can be surprisingly common in unexpected areas, such as the ears. Have you ever experienced dry skin in your ears or persistent itching in the area? These symptoms could be a sign of psoriasis in the ears, affecting both the lobe, the area behind the ears, and more internal parts such as the concha (hollow cavity of the ear) or the ear canal. These symptoms can be particularly annoying. Find out more in this article.

Impact of ear psoriasis on quality of life

Having psoriasis on or behind the ears can be particularly embarrassing, especially if the hair doesn't cover these areas.

It can cause discomfort in public settings and make you feel self-conscious under others’ gaze. Often due to a lack of awareness of this disease, people around them may perceive ear flakes as a sign of poor hygiene or infection. 

In addition, scratching ear psoriasis can cause bleeding, leaving visible pieces of dead skin on the shoulders or in the hair near the ears, which affects not only appearance but also psychological state. 

Ear psoriasis can therefore have a major impact on quality of life and cause significant psychological suffering. For a better understanding of this aspect, read our article on the psychological impact of psoriasis. 

Risks associated with the use of cotton buds and hearing loss

Every day, you need to take care of your ears, and this is particularly true when you suffer from ear psoriasis, especially as this condition can lead to dry skin in the ears, but it can also affect hearing. 

People affected by psoriasis in the ear may have poorer than normal hearing and may even experience balance problems ⁽¹⁾. 

It is therefore important to avoid using cotton buds, as they can further irritate the ears and aggravate the inflammation. Instead, opt for gentle cleansing with lukewarm water in the shower to help remove flakes without causing further irritation.

If the earlobe is an area of psoriasis, it's a good idea to remove your earrings duringa flare-up. This will make it easier to apply local treatments and increase your comfort. 

Finally, if you wear hearing aids and suffer from psoriasis near the ear canal, you may experience difficulties similar to those caused by an earwax plug ⁽¹⁾,which affects your ability to hear clearly. To avoid these complications, it is important to consult a dermatologist as soon as possible at the first signs of psoriasis in the ears. Early treatment can help you maintain good hearing quality while effectively managing the symptoms of psoriasis.

Causes and symptoms of ear psoriasis

Ear psoriasis is a specific presentatoin of psoriasis, an inflammatory skin disease that causes red, scaly patches to appear. 

Role of the immune system and inflammation

Psoriasis, including ear psoriasis, is largely due to a dysfunction of the immune system⁽²⁾.

Normally, our immune system protects the body against infection and disease. However, in the case of psoriasis, it mistakenly attacks the skin cells, which is the reason for the possible link between psoriasis and autoimmune disease. This reaction causes inflammation and accelerated production of skin cells (keratinocytes), resulting in the characteristic plaques of psoriasis. 

Genetic factors, as well as environmental factors such as bacterial infections, can also trigger or exacerbate psoriasis symptoms^(2-3).

In terms of visible signs, the symptoms of ear psoriasis include⁽⁴⁾ : 

• inflamed and reddened skin around and/or in the ear. 
• scaly patches due to the accumulation of dead skin cells.
• intense itching. 
• pain.
• hearing loss, as if the ear were blocked. 
• balance problems in cases of psoriasis inside the ear canal. 

If you experience one or more of these symptoms, consult your dermatologist. 

Medical treatments and hygiene products 

Once the diagnosis of ear psoriasis has been confirmed, the dermatologist will generally suggest a combined treatment that includes medicated creams, hygiene advice and the daily application of a psoriasis cream to soothe the skin and prevent excessive scaling. 

Use of dermocorticoids and anti-inflammatories

Dermocorticoids (corticosteroid-based medicated creams) are the first-line anti-inflammatory treatments.

They are applied directly to the affected skin to reduce inflammation and relieve symptoms.

Creams based on vitamin D derivatives, known as vitamin D analogues (calcipotriol...), may also be an option proposed by the dermatologist to act more specifically on the elimination of scaly patches. 

Phototherapy and other treatment options

In combination with local treatments, the dermatologist may suggest sessions of phototherapy for psoriasis . This is an option that can prove effective in reducing the inflammation of psoriasis in the ear. Phototherapy⁽⁵⁾ uses the beneficial effects of ultraviolet (UV) wavelengths to calm inflammation and regulate the excessive reaction of the immune system. 

As this option also has its constraints, recommendations are made on a case-by-case basis, after a full explanation of the protocol and its advantages and disadvantages.

Possible side effects of treatment

Psoriasis treatments, whether creams, gels or phototherapy, are effective, but there are possible side effects:

• Local treatments, such as dermocorticoids, are often used as a first-line treatment. Although they quickly soothe the plaques, prolonged use can weaken the skin, making it thinner and causing a rebound effect when you stop using them.⁽⁶⁾. 
• Vitamin D-based creams can sometimes cause irritant contact dermatitis⁽⁷⁾. 
• Phototherapy, which uses UV light under medical supervision, helps to slow down the renewal of skin cells. But it can also cause redness⁽⁸⁾, burning sensations and, in the long term, accelerate skin ageing.

To prevent these issues, it’s important to develop the right habits and follow your dermatologist’s advice: stick to the prescribed treatment duration, keep your skin well-moisturised to reduce irritation, and protect it from external irritants.

Regular dermatological monitoring also helps to adapt the treatment and avoid troublesome side-effects.

Routine to adopt in case of ear psoriasis

According to the recommendations of our expert dermatologist, it is very important to maintain a meticulous skin care routine to manage ear psoriasis effectively.

" For optimum ear hygiene, clean the entire outside of the ear every day, including the external cavity, the lobe and the back of the ear. Use a soap-free lipid-enriched cleansing gel to preserve the skin’s natural hydration and prevent further irritation.

Then dry with a clean handkerchief, compress or small towel. And above all, don't use a cotton bud as this could push the flakes deeper into the ear canal and cause irritation!

After cleansing, we recommend applying a daily cream to help reduce the formation of flakes and maintain the skin barrier. 

When you choose products from pharmacies, make sure they are specifically formulated to help psoriasis-prone skin, and check that they contain soothing active ingredients (such as polidocanol), anti-inflammatory ingredients (such as celastol, a plant-based active ingredient derived from biotechnology), and ingredients that help psoriatic plaques (such as vederin) to detach more easily..... This will ensure a skincare approach that not only cleanses, moisturises, but also offers therapeutic properties to manage the symptoms of ear psoriasis."

Preventing flare-ups and managing stress

Numerous studies⁽⁹⁾ show that stress can trigger psoriasis flare-ups in sufferers, and that a stressful event in the previous year increases the risk of developing psoriasis. Not to mention that living with ear psoriasis can be a source of stress in itself, creating a vicious circle between stress and flare-ups!

In fact, when we're stressed, the body releases hormones that can disrupt the immune system and encourage inflammation. The link between stress and psoriasis can therefore help us to understand why effective stress management is useful in limiting ear psoriasis. 

Use of appropriate creams and shampoos 

Inappropriate use of creams and shampoos can intensify the symptoms of ear psoriasis. Products containing alcohol in particular can cause further irritation, increase itching and increase the risk of infection, especially if the skin is already weakened by psoriasis behind the ears. 

To minimise these risks and protect your skin:

• Choose creams recommended by health professionals. 
• Opt for gentle shampoos specially designed for sensitive scalps. When using other shampoos, minimise contact with the ears, for example by washing your hair upside down to avoid the product dripping onto the affected areas. 
• Make sure you rinse out shampoos and cleansers well, as insufficient rinsing can leave traces of the product and cause further irritation to the skin around the ear.