10 Ways to Deal With Psoriasis in Your Ears

Understanding psoriasis in your ear

When you hear the word “psoriasis,” you probably picture scaly patches on the elbows or knees. But this common skin condition can appear almost anywhere on your body. That goes for the ears.

It may seem like a simple matter of location, but there’s a particular risk that comes with psoriasis in the ears. Scaly plaques that sometimes show up on, around, or in the ears can affect hearing

So how to do you manage this condition? Here, experts offer top tips for treating ear psoriasis.

What is psoriasis?

Affecting about eight million people in the United States, psoriasis is an inflammatory skin condition that occurs when your immune system goes into overdrive and amps up skin cell production.

Skin cells pile up on the surface of the skin instead of shedding. They can form raised, reddened plaques that itch and burn and may be covered with thick, silvery scales.

You might notice these plaques on your knees, elbows, feet, lower back, face, palms, or almost anywhere else on the body. Including, of course, the ears.

“Some people may have psoriasis just on their ears, but it is usually scalp psoriasis and ear involvement combined,” says Jerry Bagel, MD, a dermatologist at East Windsor Dermatology in East Windsor, New Jersey, and a member of the National Psoriasis Foundation’s board of directors.

Psoriasis is more than just a skin condition.

A growing body of research suggests that it also ups your risk for heart disease, depression, and type 2 diabetes, likely because of underlying inflammation.

As many as one in three people with psoriasis also develop psoriatic arthritis, which is characterized by swelling, stiffness, and pain in the joints.

There’s a mental health aspect too. When plaques occur on visible parts of your body, psoriasis can dampen your self-confidence, dramatically affecting your quality of life.

Ear psoriasis symptoms

In general, ear psoriasis can cause itching, redness, discoloration, and scaling. Annoying, but probably not as worrying as another possible symptom: impaired hearing.

The scaly buildup of skin cells can inch its way into your ear canal, and you may develop temporary hearing loss.

“This is the bigger problem,” says Dr. Bagel. “All of that scaling is packed into your ear canal and can impair hearing. People think they are going deaf.”

If your ears are clogged, it can affect your balance, too, and may result in vertigo.

“It feels like there is cotton in your ear canal, and you can lose a lot of hearing,” adds Bruce Strober, MD, clinical professor of dermatology at Yale University and founder of Central Connecticut Dermatology Research in Cromwell, Connecticut.

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Diagnosing ear psoriasis

When researchers set out to get a better understanding of how ear psoriasis is diagnosed and treated, they polled members of the National Psoriasis Foundation’s medical board.

They found that ear psoriasis is often a result of scalp psoriasis that had spread to the ears.

Doctors said they look at the ears when diagnosing and assessing psoriasis, but three-quarters don’t look in the ear canal, according to the study. It was published in a 2020 issue of the Journal of Psoriasis and Psoriatic Arthritis, of which Dr. Strober is editor in chief.

If you suspect you have psoriasis in your ears, make sure your doctor does more than just inspect the outside of the ear. He or she should inspect the ear canal too.

Ear psoriasis and hearing loss

It may be hard to know what type of doctor to see for ear psoriasis, particularly when your hearing is affected. A good rule of thumb is to let your symptoms guide you.

“If you can’t hear, see an ear, nose, and throat specialist,” says Dr. Bagel. “But if you can hear and have psoriasis anywhere, including your ears, see a dermatologist first to start on therapy that will prevent hearing loss.”

An ear, nose, and throat specialist (aka an ENT) can remove the buildup of scaly skin (a process known as debridement) to help restore hearing, he adds.

After this initial professional cleaning, your doctor can teach you how to do it yourself using hydrogen peroxide diluted with water.

Treating psoriasis in ears

There is no cure for ear psoriasis, but there are plenty of at-home treatments and doctor-prescribed medications to help ease symptoms.

Topical steroids

Topical steroids, such as DermOtic Oil drops, are first-line treatments for ear psoriasis, says Dr. Strober.

Skin thinning is a known side effect of topical steroids, but you won’t be using high-strength steroids in the ear area.

“This will cause skin to thin out too much in an area where it is thin to begin with,” Dr. Bagel explains.

Instead, mild- or moderate-strength steroid lotions and ointments are recommended for ear psoriasis, he says.

To get the best bang for your buck, Dr. Bagel suggests soaking a gauze pad in warm water and placing it on the affected part of your ear for five to 10 minutes.

“This will soften up the scales, and then you can apply the mild- or medium-strength steroids to decrease inflammation,” he says.

In general, topical treatments can help with pain and itchiness.

Steroid-free creams

Once the psoriasis improves, other topical therapies may play a role in keeping the ear area clear, says Dr. Bagel.

Your doctor may recommend topical calcineurin inhibitors such as tacrolimus ointment (Protopic) and 1 percent pimecrolimus cream (Elidel). These steroid-free creams are used off-label for psoriasis to reduce inflammation and itch.

Other options may include calcipotriene, a form of vitamin D that slows down skin cell growth.

Light therapy

Light therapy, also known as phototherapy, is a staple in psoriasis care, using ultraviolet light to target skin affected by psoriasis.

But it only has a limited role in ear psoriasis because the area can be hard to target with light-based devices.

Before starting a UV light therapy treatment, you’ll want to talk to your doctor about the benefits and risks, which include a higher likelihood of skin cancer.

Systemic treatments

If ear involvement is part of widespread psoriasis, biologics or inflammation-modifying drugs, like adalimumab (Humira), may help, says Dr. Strober.

Biologics block specific proteins, such as tumor necrosis factor (TNF), that increase inflammation in psoriasis.

Extraction

Your doctor can manually remove the skin that’s affecting the ear canal. Sometimes, this resolves hearing problems.

A word of warning: do not try to do this yourself or insert anything into your ear canal. You could damage your eardrum and raise your risk of hearing loss.

Lifestyle changes for ear psoriasis

Psoriasis is often marked by periods of flares and disease-free remissions where skin is clear, or pretty close to it.

Recognize triggers of flares

The best way to minimize the risk of psoriasis flares, including those that affect your ears, is to guard against the things that cause you to flare.

Common triggers include stress, injury to the skin (even a seemingly minor one), illness, and sometimes even the weather. You may not be able to avoid or change all of those things, but you can do your best to modify your behavior to reduce the likelihood of a flare-up.

If stress tends to cause you to flare, for instance, find a healthy way to cope with stress. Try practicing meditation or yoga, or take a time-out and listen to music.

Moisturize

Good skin care also makes a difference. Keeping your skin moisturized can help relieve some of the symptoms of psoriasis, such as dry skin, itching, and flaking.

Need help getting started? This is the best skin care routine for psoriasis, according to top dermatologists.

Eat psoriasis-friendly foods

It’s also important to watch what you eat. Some foods may increase your risk of a psoriasis flare.

These psoriasis-triggering foods may include dairy, tomatoes, or chili peppers.

Avoid picking or scratching plaques

It’s sure is tempting to pick or scratch raised skin. But never pick or scratch at psoriasis plaques—it can lead to an infection, says Dr. Bagel.

If that occurs, you may need a topical or oral antibiotic. Signs of infected ear psoriasis include oozing and crusting.

Check in with your doctor

Talk to your doctor on a regular basis to make sure you are doing everything you can to keep your psoriasis in check.

This includes following your doc’s orders about medication use, identifying your triggers, and making lifestyle modifications to keep your flare-ups at bay.

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