Ear Psoriasis Overview

When psoriasis plaques—red, scaly patches of skin—affect the ears, they are usually limited to the external ear (auricle and earlobe) and/or the ear canal. Psoriasis on external ear skin may be itchy, painful, and tender. Psoriasis in ears may additionally impact your hearing.

Hearing loss with psoriasis can be particularly concerning, but is usually temporary and easily treated by a healthcare provider.

This article discusses the symptoms, causes, diagnosis, and treatment of psoriasis in, on, and around the ears.

Ear Psoriasis Symptoms

Symptoms of psoriasis in the ears or on ear skin may include:

• Red, dry patches of skin covered with silvery-white scales (plaques)
• Itchiness, pain, or tenderness
• Bleeding when skin is scratched
• Scales that build up inside the ear canal
• Ear wax blockage
• Hearing loss caused by the shedding of scales from the plaques which can settle into the ear canal, mix with ear wax, and cause a complete or partial blockage

Generally speaking, it is rare to have psoriasis plaques on the ear only. Typically, there will be evidence of psoriatic lesions elsewhere on the body—such as the elbows, knees, scalp, or back.

If you have not previously been diagnosed with psoriasis, ear psoriasis symptoms may be confusing since they can mimic other ear conditions such as swimmer's ear. This is especially true if the plaques only occur in the ear canal, rather than on visible ear skin.

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.

Balance Issues and Vertigo

Psoriasis usually doesn't impact the organs of the middle or inner ear, including the eardrum or tympanic canal. However, on rare occasion, psoriasis can co-occur with psoriatic arthritis—an associated autoimmune disorder that does.

Psoriatic arthritis can affect tissues of the middle and inner ear, causing vertigo (the sensation that you are spinning or in motion) and balance problems. It can also cause sensorineural hearing loss, which results from damage to the inner ear or the auditory nerve.

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.

Causes of Ear Psoriasis

Psoriasis is an autoimmune disorder characterized by an immune system gone awry.

For reasons poorly understood, the immune system will suddenly attack its own healthy cells and tissues. With psoriasis specifically, skin cells called keratinocytes are the target of the assault. These cells 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 create the red, dry, and inflamed patches characteristic of psoriasis.

Psoriasis of the ear is not well studied, and it's unclear why some people develop the condition and others don't. However, ear psoriasis may affect 3.6% to 37% of people with psoriasis.

If psoriatic arthritis is involved, the organs of the middle ear (including the cochlea and stapes) may become targets of inflammation and impairment.

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How Do You Know If You Have Psoriasis in Your Ear?

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).

The physical exam will include an inspection of the ear 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 compact appearance, unlike that of similar skin conditions like eczema.

If vertigo is involved, you may need to see an ear, nose, and throat specialist called an otolaryngologist for a complete diagnostic evaluation. This will include 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.

How Do I Get Rid of Psoriasis in My Ears?

Ear psoriasis can't be cured, but there are medications that can help temper the inflammation and keep flares under control.

Some may be prescribed to people with psoriasis regardless of where their plaques are. Others specifically target the ear. Professional ear wax removal may be necessary to treat hearing loss.

Medications

Some medications used to treat 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
  

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.

Phototherapy

Phototherapy, also known as light therapy, can also be used to treat some types of psoriasis. This treatment involves exposing the skin to controlled amounts of ultraviolet (UV) radiation.

A specific type of light therapy called excimer laser therapy can be effective in treating smaller areas of the body, such as the ears.

Ear Wax Removal

If you have hearing loss, 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, though you may have 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.

Hygiene

If you develop psoriasis on or in the ear, the best thing to do is avoid fidgeting with the ear. Do not pick or scratch the lesions, which may only cause bleeding and make them worse.

Keep your ears clean and dry using only the mildest soaps and softest towels.

Avoiding Psoriasis Triggers

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.

Some of these triggers may be avoidable. For example, a medication you are taking may be able to be switched for another one. Or if stress is a trigger, mind-body therapies like meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (PMR) may help manage your emotions.

Coping

If you embarrassed by ear 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.

If experiencing anxiety or depression as a result of your condition, consider seeing a mental health professional who can help you sort through your emotions and prescribe antidepressants or anxiolytic (anti-anxiety) medications, if needed.