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Hey Doc, why are my ears so itchy? Itchy and painful ears - Ear Eczema

TGIF dear friends! Welcome back to TGIF Dr Euan's Blog Post :-)


Do you / loved ones suffer from persistently itchy ears? the kind that makes you want to dig / scratch inside? or recurring ear pain inside? or patin in and behind the ears? some describe it as an earache, or even a sharp ear pain!


Read on to find out more about what might be causing your itchiness or earache!


Q: What is ear eczema?

Ear eczema (atopic dermatitis) is a condition that causes your skin to become dry, discoloured, itchy and bumpy. It may appear on the outside of your ear, inside your ear canal, or both!


Eczema damages the skin barrier function (the “glue” of your skin). As a result, your skin becomes more sensitive and more prone to infection and dryness. Sometimes, you can also get a super-imposed FUNGAL skin infection, which only makes the itch more intense.


Q: Who does ear eczema affect?

Ear eczema can affect anyone's ears. However, it’s more common in people with:

  • A personal or family history of eczema

  • Asthma

  • Environmental allergies

  • Hay fever (allergic rhinitis)

Q: How common is ear eczema?

Eczema is actually very common, and any part of your skin can develop it, including your ears.

Approximately 15% to 30% of children have eczema, and 2% to 10% of adults have it. So don't worry if you have eczema, it is important to get an accurate diagnosis and treatment, and prevent flareups.


Q: How does ear eczema affect my body?

Areas affected by ear eczema can include:

  • Your outer ears (pinna), including your ear lobes

  • Your inner ear canals

  • Behind your ears

  • The skin between your ears and your face

Your skin may itch, change colour, develop bumps, dry out or even thicken.


In severe cases of ear eczema, your skin may crack or leak (weep) a thick, yellow or white fluid (pus), when an ear infection takes root.


You may also experience a ringing noise (tinnitus) or hearing loss if you have a severe case of ear eczema in your ear canals, and your ear becomes blocked up with skin debris


Q: What does ear eczema look like?

Severe eczema on the skin of the outer ear (pinna)


Symptoms of ear eczema include:

  • Itchy skin.

  • Dry skin.

  • Discoloured rashes.

  • Bumps on your skin.

  • Leathery patches of skin.

  • Crusty skin.

  • Swelling.

Ear eczema does not hurt. However, if you scratch your ear eczema, you may break the skin, leading to a skin infection that can be painful; you may have otalgia (ear pain) and otorrhea (ear discharge) as a result.


Q: Is ear eczema contagious?

Ear eczema is NOT contagious.

You cannot spread ear eczema to another person through skin-to-skin contact.


Q: What tests will be done to diagnose ear eczema?

Your doctor can typically diagnose ear eczema after a physical examination.

However, if there is any doubt, they may perform the following tests:

  • An allergy skin test

  • Blood tests to check for causes of a rash that might be unrelated to ear eczema

  • A skin biopsy to distinguish one type of dermatitis from another (this is rare)

You may take a skin prick allergy test to determine if allergies are triggering your eczema attacks

Q: How do I clear the eczema in my ears?

To get rid of your ear eczema, it is important to determine what may be causing it.


On your part, do try to determine what triggers or worsens your ear eczema, and then avoid it.

The goal is to reduce itching and discomfort and prevent ear infection and recurrent flare-ups.


The following home remedies may help to relieve your ear eczema:

  • Avoid common allergens, including earrings made of nickel, cobalt or copper (these metals are commonly used in the design and manufacture of earrings)

  • Use a humidifier if dry air makes your skin dry.

  • Wear a warm hat that covers your ears when you are out in cold weather.

  • Avoid rubbing or scratching your skin.

  • Apply a hydrocortisone cream or ointment. Hydrocortisone is a corticosteroid combined with an anaesthetic pain reliever. It relieves itching and discolouration.

  • Moisturise your skin using a cream or ointment. Lotions usually don’t work as well. Apply several times a day, including after your bath or shower. Moisturisers help trap to moisture in the skin.

  • Bathe or shower in lukewarm — not hot — water. Gently wash your ears. Limit the amount of time you spend in the water to under 15 minutes.

  • Use mild soaps and hair and skin care products that are free of perfumes, dyes and alcohol. Look for products labeled “fragrance-free,” “hypoallergenic” or “for sensitive skin.”

  • Use mild laundry soap, and thoroughly rinse your clothes.

  • Use skin products that contain ceramide. These products replace some of the “glue” (the barrier) missing from your skin in eczema.

  • Wear cotton clothes. Wool, silk and other fabrics can dry your skin.

  • Take over-the-counter (OTC) antihistamines for severe itching.

  • Take prescription medications. Your doctor may prescribe steroid creams, pills, shots or ear drops. Long-term risks include side effects like high blood pressure, weight gain and thinning of the skin with prolonged use of oral cortico-steroids. There are newer medications, called topical immuno-modulators (TIMs), that show progress in treating patients who do not respond to other treatments. TIMs change the body’s immune response to allergens and have fewer side effects.

  • Try phototherapy. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps. The ultraviolet light waves found in sunlight can help certain skin disorders, including eczema.

Q: Will petroleum jelly help ear eczema?


Petroleum jelly (Vaseline™) or skin care ointments (Aquaphor™) can help treat your ear eczema.

These products help to moisturise and protect your affected skin. They are hypoallergenic and have anti-bacterial and anti-fungal characteristics that help heal your skin.


Gently wash your ears with warm running water and mild soap. Then, use a cotton swab to apply a small amount of petroleum jelly or skin care ointment over your ears. Try to avoid touching your ears with your fingers to prevent dirt or bacteria from entering the area.


Q: How can I reduce my risk of getting ear eczema?


There are steps you can take that may prevent / reduce ear eczema outbreaks:

  • Establish a skincare routine, and follow your doctor’s recommendations for keeping your skin healthy.

  • Avoid wool and silk, which can dry out your skin.

  • Use a mild soap for your bath or shower, and pat your skin dry instead of rubbing it. Apply a moisturising cream or ointment immediately after drying your skin to help seal in the moisture. Reapply cream or ointment two to three times a day.

  • Take baths or showers with lukewarm water, not hot water.

  • Drink at least eight glasses of water each day. Water helps keep your skin moist.

  • Avoid sudden changes in temperature and humidity.

  • Limit your exposure to known irritants and allergens.

  • Avoid scratching or rubbing your irritated skin.

Q: What can I expect if I have ear eczema?


If you have ear eczema, it can generally be well-managed with good skin care and treatment. However, flare-ups of symptoms can occur throughout your life.


Q: Can ear eczema be cured?

Ear eczema is a chronic condition, which means there is NO long term cure.

However, treatments are very effective in reducing the symptoms of dry, itchy skin.


If you would like to consult Dr Euan about ear eczema or any other ENT related issues, you can book an appointment with us here.


Meanwhile, have a good ITCH free weekend!


Finally, here are some useful references if you would like to delve deeper into the topic of EAR ECZEMA:


References:

1.Celebi Erdivanli, O, Kazikdas, KC, Ozergin Coskun, Z. Skin prick test reactivity in patients with chronic eczematous external otitis. Clin Exp Otorhinolaryngol. 2011;4:174-176. Google Scholar | Crossref | Medline | ISI

2.Jacobsson, S, Karlsson, G, Rigner, P. Clinical efficacy of budesonide in the treatment of eczematous external otitis. Eur Arch Otorhinolaryngol. 1991;248:246-249. Google Scholar | Crossref | Medline | ISI

3.Eichenfield, LF, Tom, WL, Berger, TG. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116-132. Google Scholar | Crossref | Medline | ISI

4.Kaushik, V, Malik, T, Saeed, SR. Interventions for acute otitis externa. Cochrane Database Syst Rev. 2010;(1):CD004740. Google Scholar

5.Lubach, D, Bensmann, A, Bornemann, U. Steroid-induced dermal atrophy: investigations on discontinuous application. Dermatologica. 1989;179:67-72. Google Scholar | Crossref | Medline

6.Sood, S, Strachan, DR, Tsikoudas, A. Allergic otitis externa. Clin Otolaryngol Allied Sci. 2002;27:233-236. Google Scholar | Crossref | Medline | ISI

7.Fraki, JE, Kalimo, K, Tuohimaa, P. Contact allergy to various components of topical preparations for treatment of external otitis. Acta Otolaryngol. 1985;100:414-418. Google Scholar | Crossref | Medline | ISI

8.Saunders, JE, Raju, RP, Boone, JL. Antibiotic resistance and otomycosis in the draining ear: culture results by diagnosis. Am J Otolaryngol. 2011;32:470-476. Google Scholar | Crossref | Medline | ISI

9.Henatsch, D, Wesseling, F, Kross, KW. Honey and beehive products in otorhinolaryngology: a narrative review. Clin Otolaryngol. 2016;41:519-531. Google Scholar | Crossref | Medline | ISI

10.Lu, J, Carter, DA, Turnbull, L. The effect of New Zealand kanuka, manuka and clover honeys on bacterial growth dynamics and cellular morphology varies according to the species. PLoS One. 2013;8:e55898. Google Scholar | Crossref | Medline | ISI

11.Estevinho, ML, Afonso, SE, Feas, X. Antifungal effect of lavender honey against Candida albicans, Candida krusei and Cryptococcus neoformans. J Food Sci Technol. 2011;48:640-643. Google Scholar | Crossref | Medline

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13.Al-Waili, NS . Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Eur J Med Res. 2001;6:306-308. Google Scholar | Medline | ISI

14.Bos, JD, Brenninkmeijer, EE, Schram, ME. Atopic eczema or atopiform dermatitis. Exp Dermatol. 2010;19:325-331. Google Scholar | Crossref | Medline | ISI

15.Al-Waili, NS . Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study. Complement Ther Med. 2003;11:226-234. Google Scholar | Crossref | Medline | ISI

16.Maruhashi, E, Braz, BS, Nunes, T. Efficacy of medical grade honey in the management of canine otitis externa—a pilot study. Vet Dermatol. 2016;27:93-98e27. Google Scholar | Crossref | Medline | ISI

17.Birnie, AJ, Bath-Hextall, FJ, Ravenscroft, JC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Cochrane Database Syst Rev. 2008;(3):CD003871. Google Scholar

18.Ten Broeke-Smits, NJ, Kummer, JA, Bleys, RL. Hair follicles as a niche of Staphylococcus aureus in the nose: is a more effective decolonisation strategy needed? J Hosp Infect. 2010;76:211-214. Google Scholar | Crossref | Medline | ISI

19.Onunkwo, CC, Hahn, BL, Sohnle, PG. Clearance of experimental cutaneous Staphylococcus aureus infections in mice. Arch Dermatol Res. 2010;302:375-382. Google Scholar | Crossref | Medline | ISI



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