Unhappy Q-tips standing next to and peering into an oversized ear

Psoriasis in the Ear Canal

I have psoriasis where the sun doesn't shine. Not there! Although genital psoriasis is another topic well worthy of discussion, I am talking about psoriasis in the ear canal.

I have managed my ear psoriasis with the same strategies for the last 25 years, and it wasn't until I went partially deaf did I learn my strategies for managing ear psoriasis were all wrong.

Am I going deaf?

I went to my doctor because I felt like I was going a little deaf. I thought psoriasis that lives in my ear canal was causing a blockage. Surprisingly it turned out I was a lot deafer than I had realized.

Even more surprising, the problem itself was not psoriasis-related (although temporary hearing loss can be). It was a fluid accumulation behind my eardrum. The lesson? Hearing loss can accumulate over time, especially with psoriasis, and you may not notice it until it is significantly affecting your life.

Quality of hearing is a question I don't think dermatologists really ask. In the last thirty years, not one of my dermatologists has ever asked me about hearing loss, and it is another one of those questions that should be asked more frequently.

Specific symptoms

I don't know about you but I have always managed the frustrating itch and thick feeling inside my ears by using a cotton swab on very soft scales.

Getting right into my ear with a cotton swab gave me a feeling of relief that is similar to the way a dog loses control of one of its legs when you scratch it in just the right place. The problem is that this isn't a recommended practice, and for a good reason.

Temporary hearing loss

When we have scaling inside the ear, and insert a cotton swab, we risk pushing scales further into the ear. This can lead to compaction. This thicker mass can create a blockage which can cause further pressure on your ear canal, causing more itching and can hinder sound waves from reaching your inner ear and leading to hearing loss.

I knew I was in trouble with my doctor when he scolded me with "your ear canal is squeaky clean. What have you been doing in there?" So much for cleanliness being next to godliness. I suppose this is another case of the body being able to clean its own ear canal - and really - if we can, we should trust our body to do the work.

What are treatment options for psoriasis in the ear?

No. I tried. I tried really hard. After about six weeks I gave in. I couldn't do it. So what can we do? The best thing to do is to initiate a conversation with your dermatologist.

There are several treatment options for psoriasis in the inner ear, but as the skin is so delicate you should not take a steroid you have already been prescribed and try and shove it in your ear.

  • Topicals: You may be prescribed mild topical steroids, vitamin D agents or Calcineurin inhibitors. Be honest with your derm even if they frown at you. It's better to deal with a frowny face now than cause more permanent hearing loss because of inappropriate use or application of topicals.
  • U.V.: This isn't going to get into your ear canal, but if you struggle with psoriasis in the external parts of the ear and behind the ear that make it more intolerable, there are small handheld devices which may be suitable.
  • Systemic options: If psoriasis in your inner ear is causing you so much aggravation that it's hindering your life and the topicals haven't worked or you have more widespread psoriasis your dermatologist may refer you for more systemic therapy.

The critical thing to take away here is that there are multiple options for treating psoriasis in this location if you remember to ask your dermatologist the right questions at your next appointment.

Talk with your doctor

Even your doctor may be able to help. Anti-histamines may help with the itching and mild topical steroid usage can help too. Your doctor could even refer you to an ENT specialist instead of a dermatologist depending on your symptoms.

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