Recently, Gail Porter used to leave a pair of earrings and small jewelry in her ears while she slept at night. It was flat, round, and gold-colored—a Los Angeles-based entertainment attorney believed it was gold-filled, not gold-plated.
This distinction was important to her because she knew that gold-plated jewelry (which only has a thin layer of gold on the outside that could easily flake off, exposing the base metal underneath) could irritate her skin.
When Porter’s earlobes became red, swollen, itchy, and hot to the touch, she decided that the earrings might have been gold-plated after all and that she was allergic to the metal inside, perhaps nickel or cobalt.
The outer parts of her ears smashed into a scaly, itchy rash, too, as well as wrinkles behind her ears — signs of atopic dermatitis.
Based on previous experience, Porter believes her allergic reaction to the earrings caused the outbreak.
How does Atopic Dermatitis affect the ears?
Atopic dermatitis, the most common form of eczema, is caused by an overactive immune system that produces inflammation and causes the skin barrier to dry out and irritate, according to the National Eczema Association (NEA). A non-infectious condition is usually associated with dry, itchy rash-like symptoms of the face, neck, arms, hands, feet, ankles, soles of the elbows, and the backs of the knees.
But any area of the skin can develop atopic dermatitis, including the ears, says JiaDe “Jeff” Yu, MD, a dermatologist and director of the Dermatology and Contact Dermatology Clinic at Massachusetts General Hospital in Boston.
In fact, he adds, the outer ear can be particularly susceptible to atopic dermatitis because it dries up easily, unlike some areas of the body where there are more sebaceous and sweat glands, including the armpits, groin and scalp.
Symptoms are similar to what might occur elsewhere in the body: “Itching, scaling, and redness are by far the most common,” says Dr. Yu. The rash can look purple, dark brown, gray, or grayish-white on darker skin tones, according to the Asthma and Allergy Foundation of America.
The rash may hurt, Yu says, “especially if scratching leads to open sores and bacterial infection.”
What causes ear eczema?
As Porter learned, atopic dermatitis can be caused by allergic contact dermatitis — when your skin has an allergic reaction to substances you touch. Yu says metal in jewelry is a common cause.
He adds that in-ear headphones, foam earplugs, and ear drops are other culprits, and the reaction can affect the ear canal.
Picking or rubbing the skin in and around the ears can also cause a flare-up. “It’s best to avoid scratching and rubbing these areas,” says Peter Liu, MD, a Chicago-based dermatologist and a member of the NEA’s Board of Directors and Clinical Advisory Board.
Like Yu, Dr. Liu points to dry skin as a possible cause. He notes: “Very few people moisturize around the ears, and this may also help explain why eczema is more likely.”
How to avoid and treat Atopic Dermatitis in the ears
To reduce eczema flare-ups, Yu, also affiliated with NEA, recommends:
- Avoid jewelry or choose styles made of metals that are unlikely to cause an allergic reaction, such as surgical steel, titanium, gold, silver, or platinum.
- Do not wear headphones or earplugs for an extended period of time.
- Minimize exposure to cold, dry air. Use a humidifier and earmuffs during the cold weather months.
- Apply a thick moisturizer to the ears, such as Vaseline, to help seal in the moisture.
Doctors can do what’s called a patch test on an area of skin to see if a particular substance may be causing an allergic reaction that could trigger a flare-up of atopic dermatitis.
Doctors can also treat atopic dermatitis involving the ears with topical medications that suppress the immune response, such as the following:
Lio says that treating atopic dermatitis in the ear area can be a challenge because the skin is sensitive and sometimes hard to reach.
“if [the eczema] Just below and behind the ear, creams or ointments usually work well in those areas,” Liu says. “If there are cuts or fissures, it may be best to use a greasy ointment that is less likely to sting than a cream, gel, or liquid. Things get even more difficult if the ear canal itself has eczema: then we often use oil [steroid] Ear drops to help get in a bit and calm the inflammation and itching.”
As for over-the-counter treatments, Jill Porter found that wetting her ears and face with an over-the-counter lotion containing colloidal oatmeal helped her feel better. “I just started rubbing it on my ears, behind them, and on my face. My eczema is now pretty much almost gone,” she says.
Her advice to others prone to atopic dermatitis: “Take off your jewelry every night. Don’t bathe in it. Don’t sleep in it.”
Seborrheic dermatitis can affect the ears and eyebrows too
If you experience itching, flaking, and discoloration in or on the inside of your ears, atopic dermatitis may not be the problem. You may be dealing with seborrheic dermatitis, also known as scalp eczema because it is more common on the skin on top of the head.
“Seborrhoeic dermatitis is a fancy term for dandruff. It can occur anywhere the skin is rich in oils, such as inside the ears and the ear canal. The crease behind the ears and even the eyebrows can be affected,” says Yu.
Yu adds that heat, sweating, sweat trapping, and oils can all be factors that trigger an outbreak of seborrheic dermatitis.
The underlying cause of seborrheic dermatitis may be a genus of yeast-like fungi on the skin known as Malassian. “Maybe that Malassian It eats excess fat and then the immune system reacts to an overgrowth of yeast on the skin,” says Liu.
How to treat and prevent seborrheic dermatitis on the ears and eyebrows
Yu uses several types of medication to treat seborrheic dermatitis. “In general, I try to reduce Malassian yeast with [antifungal] A cleanser of some kind, such as ketoconazole or ciclopirox. Next, I have patients who use a topical anti-inflammatory such as a corticosteroid, or a non-steroidal agent such as a topical calcineurin inhibitor,” says Yu.
According to Yu, antifungal creams are also a treatment option.
You can avoid bouts of seborrheic dermatitis by “avoiding earphones in summer and prophylactically [preventively] Yu recommends washing the skin with an anti-dandruff shampoo.
Following a regular skincare routine can help keep symptoms of seborrheic dermatitis at bay, according to the NEA, which recommends washing affected areas every day with a gentle 2% zinc pyrithione cleanser (Head & Shoulders and Selsun Blue are over-the-counter examples) followed by a moisturizer.
Daily shampoo is acceptable for people with seborrheic dermatitis who have naturally straight hair, according to an article published by Brownskin.net, a website founded by Penn Medicine dermatologist Susan C. Taylor, MD. Individuals with curly, tightly coiled, or straight hair that is more brittle, dry, and prone to breakage—especially black women—should wash once or twice weekly, as directed by their doctor.
Jill Porter, who is black and has also had bouts of seborrheic dermatitis on the scalp and behind her ears, says keeping washing her hair once or more a week has helped eliminate flaking and itching in both areas.
To avoid problems with wrinkles behind her ears, she makes sure to dry that area well after every shampoo. “Don’t allow it to stay wet,” she warns.