This article discusses the symptoms, causes, diagnosis, and treatment of ear psoriasis.
Symptoms
Psoriasis of the ear is usually limited to the external ear (comprised of the auricle and earlobe) and/or the ear canal (auditory canal). It doesn’t usually affect the organs of the middle or inner ear, including the eardrum (tympanic membrane) or tympanic canal. Symptoms may include:
Red, dry patches of skin covered with silvery-white scales (plaques) Itchiness, pain, or tenderness on or in the ear Bleeding when scratched Ear wax blockage Hearing loss
If you have not previously been diagnosed with psoriasis, these symptoms may be confusing since they can mimic other ear conditions such as swimmer’s ear. This is especially true if the plaques occur in the ear canal only.
In some cases, it may take a complete physical exam to make the connection between a spattering of plaques on one part of the body and hearing problems only in one ear.
On rare occasion, psoriasis can co-occur with an associated autoimmune disorder known as psoriatic arthritis. Psoriatic arthritis can affect tissues of the middle and inner ear, causing vertigo and balance problems.
Causes
Psoriasis is an autoimmune disorder characterized by an immune system gone awry. For reasons poorly understood, the immune system will suddenly attack its own cells and tissues. With psoriasis specifically, the target of the assault will be skin cells called keratinocytes which make up around 90% of the outer layer of skin (epidermis).
The inflammatory response will effectively speed up the division and growth of these cells, causing them to build up faster than they can be shed. As the cells are propelled to the surface, they will create the red, dry, and inflamed patches characteristic of psoriasis.
Psoriasis does not target mucosal cells, such as those of nose, eardrum, or inner ear. This is why psoriasis may develop on the face, but not in the mouth.
Any hearing loss associated with psoriasis is caused by the shedding (sloughing) of scales from the plaques. The flakes can infiltrate the auditory canal, comingle with ear wax, and cause a complete or partial blockage.
If psoriatic arthritis is involved, the organs of the middle ear (including the cochlea and stapes) may become targets of inflammation and impairment. According to a 2014 study in the Journal of Rheumatology, 60% of people with psoriatic arthritis experience some level of hearing loss, while 23% experience vertigo or balance problems.
Diagnosis
Ear psoriasis is generally diagnosed with a physical exam. In addition to identifying the characteristic plaques, the healthcare provider will review your medical history to assess your risk for the disease (including a family history of psoriasis or other autoimmune disorders).
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The physical exam will include an inspection of the auditory canal with a lighted device called an otoscope. If the results of the physical exam are inconclusive, the practitioner may take a scraping of skin cells and examine them under a microscope. Psoriatic skin cells tend to have an abnormally dense and compacted (acanthotic) appearance, unlike that of similar skin conditions like eczema.
If vertigo is involved, you may need to see an otolaryngologist for a complete diagnostic evaluation, including hearing and balance tests, magnetic resonance imaging (MRI) scans of the internal ear structure, and a rheumatoid factor (RF) blood test if psoriatic arthritis is suspected.
Treatment
Prior to treatment of any kind, your healthcare provider will likely want to remove the buildup of wax and skin cells from the ear canal. This alone can help restore hearing loss. It may be necessary to have this done on a regular basis to keep the ear canal clear. Never use cotton swabs to remove wax from the ear canal, as doing so can push the wax deeper into the ear and may even end up rupturing the eardrum.
There is no cure for psoriasis, but there are medications that can help temper the inflammation and keep flares under control. Some of these medications are not suitable for the delicate tissues of the auditory canal and adjacent eardrum.
Treatment options for ear psoriasis include:
Steroid ear drops, available by prescription OTC hydrocortisone or calcipotriene ointments to treat psoriasis on the external ear Antifungal dandruff shampoos to prevent secondary fungal infections Commercial earwax softeners to gently remove wax at home Drops of warm olive oil to moisten and loosen ear wax Oral antibiotics if a bacterial infection develops
Before using any over-the-counter psoriasis remedy, speak with your healthcare provider to make sure it is appropriate for the ear.
Moderate to severe psoriasis may require systemic medications to temper the immune response that triggers flares. Depending on the severity of your symptoms, these may include:
Methotrexate, a disease-modifying antirheumatic drug (DMARD) Acitretin, an oral retinoid drug used to reduce inflammation Biologic drugs, such as Humira (adalimumab), Enbrel (etanercept), Taltz (ixekizumab), Cosentyx (secukinumab), and Stelara (ustekinumab).
These oral and injectable medications are also effective in managing symptoms of psoriatic arthritis.
In addition, you should work with your practitioner to identify the triggers that can instigate a flare. These vary from one person to the next and may include stress, medications, cold temperatures, skin trauma, infections, and alcohol. Even the friction caused by cotton swabs can be enough to instigate an acute flare.
Coping
It is not known why some people with psoriasis develop ear plaques and others don’t. And, unfortunately, there may not be anything you can do to prevent it. Even people who practice good hygiene can develop ear psoriasis.
If you develop psoriasis on or in the ear, the best thing to do is avoid fidgeting with the ear. See a healthcare provider, and keep your ears clean and dry using only the mildest soaps and softest towels. Do not pick or scratch the lesions, which may only cause bleeding and make them worse.
If embarrassed by the plaques, you may be able to cover them with a hat, but avoid any that are tight or cause friction on or around the ears. Sunlight can often help reduce psoriasis plaques, but limit your exposure to no more than 30 minutes (and wear plenty of high-SPF sunscreen).
If stress is a trigger, practice mind-body therapies to help manage your emotions. These include meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (PMR).
If experiencing anxiety or depression as a result of your condition, consider seeing a therapist or psychiatrist who can help you sort through your emotions and prescribe antidepressants or anxiolytic (anti-anxiety) medications, if needed.
