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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. And by wrong I mean they worked for me but were not recommended by any of my doctors, and as usual, for a good reason. So what happened?

I noticed I was going deaf

I went to my G.P because I felt like I was going a little deaf and thought the psoriasis that lives in my ear canal was maybe causing a blockage. Surprisingly it turned out I was a lot deafer than I had realized and that the problem itself was not psoriasis-related (although temporary hearing loss can be), but in this instance 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.

The dreaded Q tip?

I don’t know about you -but I have always managed the frustrating itch and thick feeling inside my ears by using a Q tip on very soft scales – after a bath or swimming where my ears have been underwater.

I tried the baby ones that stop you from being able to push it too far into the ear, but they just didn’t hit that spot. Getting right into my ear with a Q tip 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 Q tip (earbud), we risk pushing scales further into the ear. This can lead to compaction – where scales are pushed to the bottom of the ear canal and then get pushed together to form a thicker mass.

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 (albeit temporary). I knew I was in trouble with my G.P 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.

Can I leave my ears to clean themselves?

No. I tried.

I tried reeeeeeeaaaallly 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.

What are treatment options for psoriasis in the ear?

  • Topicals-You may be prescribed mild topical steroids, vitamin D agents or Calcineurin inhibitors. Just make sure that you have been prescribed the topicals you are inserting into your ear for use inside the ear. If you plan to use a tool to help to apply the cream then make sure you ask about whether it is safe to use a Q tip to get it deeper into the ear canal. 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 G.P may be able to help. Anti-histamines may help with the itching and depending on your G.P training he may be able to advise mild topical steroid usage and refer you to an ENT specialist instead of a dermatologist (Ear, Nose and Throat) depending on your symptoms.

The final take away (just in case your thinking of sneaking the Q tip back down your ear canal) – is to consider that because of the Koebner effect – where damaging or irritating the skin can increase inflammation and encourage the formation of new plaques – so using a Q tip may actually make psoriasis worse.

Food for thought.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The PlaquePsoriasis.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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