Common contact allergens include nickel-containing earrings and numerous beauty products (eg, hairsprays, lotions, hair dye). Aural eczematoid dermatitis is more common among people with a predisposition toward atopy and with other similar dermatitides (eg, seborrhea Seborrheic Dermatitis Seborrheic dermatitis is a common inflammatory condition of skin regions with a high density of sebaceous glands (eg, face, scalp, sternum). The cause is unknown, but species of Malassezia... read more 
, psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including... read more 
).
Both contact dermatitis Contact Dermatitis Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Symptoms include pruritus and... read more 
and aural eczematoid dermatitis cause itching, redness, clear (serous) discharge, desquamation, hyperpigmentation, and, sometimes, fissuring. A secondary bacterial infection can occur (acute otitis externa External Otitis (Acute) External otitis is an acute infection of the ear canal skin typically caused by bacteria (Pseudomonas is most common). Symptoms include pain, discharge, and hearing loss if the ear canal... read more 
) which tends to have more pain than itching.
Treatment of Chronic Otitis Externa
Avoidance of triggers and/or irritants, including water and cotton-tipped applicators
Usually topical corticosteroids
Contact dermatitis of the ear requires avoidance or withdrawal of allergic triggers, especially earrings. Trial and error may be needed to identify the offending agent. Topical corticosteroids (eg, 1% hydrocortisone cream or a more potent 0.1% betamethasone cream) can decrease inflammation and itching. Patients should avoid using cotton swabs, water, and other potential irritants in the ear, because these will aggravate the inflammatory process. Recalcitrant cases can be treated with a short course of an oral corticosteroid (eg, prednisone).
Aural eczematoid dermatitis can be treated with dilute aluminum acetate solution (Burow solution), which can be applied as often as required for comfort. Itching and inflammation can be reduced with topical corticosteroids (eg, 0.1% betamethasone cream). If acute external otitis Treatment ensues, careful debridement of the ear canal and topical antibiotic therapy (eg, ciprofloxacin 0.3%/dexamethasone 0.1% ) may be required. Potential irritants, including water and cotton swabs, should be avoided.
Treatment reference
1. Kesser BW: Assessment and management of chronic otitis externa. Curr Opin Otolaryngol Head Neck Surg 19(5):341-347, 2011. doi: 10.1097/MOO.0b013e328349a125.
