Dear Dr. Bailey,
After many years, I now know that I have seborrheic dermatitis and it’s in my ears as well as on my scalp, nose, eyebrows, and eyes (blepharitis). Through the years I have been prescribed various drops for my ears, and they are only temporarily effective. Of all the body parts affected by my seborrheic dermatitis, the ear canals are the worst area to treat and they itch the worst. Also, the dandruff started in my ears years before the other areas of the body. Do you know of anything that might help? GW S.
Dandruff in your ear canal can cause an absolutely insatiable itch that’s impossible to reach! Patients are so appreciative when I fix it for them; it’s one of those little things that really makes a big impact on someone’s life.
I’ve found that my patients usually experience relief when they use the recommendations that I published for crusty ears affected by seborrheic dermatitis. The trick is that they have to be sure to carry this treatment down into the opening of the ear canal.
I have my patients use a baby wash cloth and dandruff shampoo to wash their ears. These wash cloths are thinner than normal wash cloths so it’s possible to reach into the ear canal opening a little. They leave the shampoo on the skin for 5 minutes in the shower before rinsing it off. It’s important to rinse all the shampoo off of the skin because shampoo residue is irritating.
I then have them apply a very small amount of lotrimin (clotrimazole) solution, using a cotton tipped applicator or their fingertip, just into the opening of the ear canal. (Cotton tipped applicators should not be inserted down into the ear canal!) The lotrimin product will melt down into the canal as it heats to body temperature. If the itch and inflammation does not begin to improve after about a week then we add a little 1% hydrocortisone cream or solution, applied twice a day after the lotrimin. If after about 6 to 8 weeks things are not improving then it’s time to come back to see me and possibly for me to refer them to an ear/nose/throat doctor for an exam.
I recommend that my patients maintain control of their ear canal dandruff by using the dandruff shampoo indefinitely to wash, and by occasionally applying the lotrimin the minute the itch begins to return. Hydrocortione can be added too if needed. The important point is to never let the dandruff get really bad again because it’s much harder to regain control of a bad flare-up, than it is an early one. I find that it’s also important to control all the areas of skin involved with dandruff; when dandruff is active somewhere, other areas are more likely to ‘misbehave’ too.
Ear canals are tricky because they have a unique group of bacteria and yeast germs living in them and sometimes these germs play a role in the problem. I’ve seen some interesting and unusual infections of the skin of the ear canal that required treatment with antibiotics. Because the germ population there is unusual, I often have to use antibiotics that I don’t normally use for skin infections.
The take home message is that dandruff in the ear canal is more complex than dandruff on other areas on the skin. Sometime there’s just no substitute for getting the help of a dermatologist or ear/nose/throat doctor for this really frustrating problem-and sometimes that doc needs to think outside the usually treatment options if the problem isn’t improving.
Lastly, and very importantly, I tell my patients to try not to scratch down in the ear canal, even if the itch is intense. Scratching will break open the skin of the ear canal and increase the chances of this rash getting infected with those unusual bacteria and yeast.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.
For more of my information on dandruff, you may want to read:
Dermatologist’s Tips For Dry, Flaky Skin On Your Face and Scalp; ‘Tis the season for seborrheic dermatitis (the first of a series of articles)