Seborrheic Dermatitis of the External Ear Canal

Patient Information Sheet

The Special Case of Seborrheic Dermatitis of the External Ear Canal

It has only taken me 40 years to figure this out. So, listen
up.

This is not a real bad condition to have. It is not life
threatening. But, sometimes this dermatitis can get secondarily
infected with Staph aureus bacteria. At that point, it becomes
serious, still not life threatening, but potentially serious. I know.
I have had it happen to me twice.

What Is It?

I have described seborrheic dermatitis in a separate patient
information sheet. If you did not get it, please ask me or my
secretary for a copy. Read it first, and then come back and read
this.

Seborrheic dermatitis is an inflammation of the skin that
just about everybody gets to some extent. It will seem like an itchy,
scaly dandruff. But it is not dandruff. The scaliness of dermatitis
seems like dry skin. So, here today we are talking about itchy dry
skin in the outer ear canal. That's the part you can stick your pinky
finger into about 1/4". That's the part you try to clean out with a
Q-Tip when you clean your ears.

Usually people with this problem also get some dry, scaly
itchy patches on the scalp too. It commonly occurs in the eyebrows
and the sides of the nose. Rarely, it occurs on the middle of the
chest and back, under the arms (that one always goes misdiagnosed) and
in the groin areas.

It can be confused with psoriasis. In olden times, some
dermatitis talked about seborrhiasis (seborrhea + psoriasis) when they
could not figure out which it was.

What's the Big Deal?

Why all the fuss? In general, this is a mildly annoying
nuisance. However, sometimes it gets a bacterial infection in it.
This presents as stubborn dry skin that gets moist or wet and itches.
It may be sore. When you clean your ears with a Q-Tip, the yellow
stuff stinks. From there it may creep out and spread to other areas
like the face. This turns into the standard honey crusted, red sores
of impetigo.

How Do You Treat It and Why Is It So Misunderstood?

The confusion is the dry-skin-like nature of the dermatitis.
It seems like dry skin, but it is really inflamed skin. Others can
see it on you, but you cannot adjust mirrors well enough to see it on
your ownself. That's how we talk in Virginia, your ownself.

I have found it common for ENT doctors to see this only as
dryness. Their approach is to instruct patients to use an oil, like
mineral oil or olive oil. One Bozeman ENT doctor in 1976 told his
patients to use 3-In-One Oil. Don't do that.

The treatment is very simple. Put a drop of Lidex
(fluocinonide) solution on the tip of your little finger and gently
rub it into the rash area. Do not jam it deep into your ear with a
Q-Tip. You might poke your eardrum. Do not apply it to your
face.

I have found that sometimes, a single application may work.
I use it once every week or two. You won't need it every day. If
that is not working after a week, it may be infected.

If it gets infected with Staph aureus bacteria, it will
probably require taking pills like minocycline or Bactrim for ten
days. Several topical antibiotics such as Altabax and Bactroban might
work. If antibiotics taken by mouth are a problem for you, consider
the these prescription ointments. They are easy and safe to use.
Pills may work better. Let's talk about your wishes.

Treatment Options

Do nothing- If it does not bother you and
does not get infected, that's okay.

Occasional topical Lidex
solution.

Oral Medicines (pills): antibiotics for infection,
topical or pills.

A word about using Q-Tips. They are great
unless you jam earwax down into the ear canal and pile it up year
after year until it blocks your hearing. If that happens, in my
opinion, the only thing you can do is to pay to see an ENT doctor and
have him dig out the dry old compacted earwax using special
instruments and a microscope. If you are having trouble with your
hearing, see an ENT doctor. They're great.

The information provided in these patient information sheets
is offered for general informational and educational purposes only; it
is not offered as and does not constitute medical advice. In no way
are any of the materials presented meant to be a substitute for
professional medical care or attention by a qualified practitioner,
nor should they be construed as such.