Dermatitis of the ear canal is a chronic inflammatory skin condition characterized by pruritis, scaling, flaking, and erythema of the skin of the external auditory meatus or the ear canal. Dermatitis can be caused by exposure to allergens (contact dermatitis) or chronic use of cotton-tipped applicators, can be part of a generalized dermatitis (eg, psoriasis), or can be spontaneous (chronic otitis externa, aural eczematoid dermatitis).
Otitis externa refers to an inflammation of the external auditory meatus (also called the ear canal or acoustic meatus). Chronic otitis externa refers to persistent inflammation that lasts longer than 3 months (1). Contact dermatitis is a cause of chronic otitis externa; dermatitis may be caused by either allergens or irritants. Allergens frequently cause chronic otitis externa; common contact allergens include nickel-containing earrings and numerous beauty products (eg, hairsprays, lotions, hair dye).
Chronic otitis externa is sometimes called aural eczematoid dermatitis when it is caused by underlying dermatologic conditions (eg, atopic dermatitis, psoriasis, seborrheic dermatitis, irritant contact dermatitis).
Bacterial or fungal infections may also rarely cause chronic otitis externa; however, these infections more commonly cause an acute otitis externa (1).
Symptoms of chronic otitis externa include itching, erythema, clear (serous) discharge, desquamation, hyperpigmentation, and, sometimes, fissuring. Pruritis is a predominant feature of atopic otitis externa (contact dermatitis and aural eczematoid dermatitis-induced). A secondary bacterial infection (acute otitis externa) typically causes more pain than itching. Irritants (eg, water, cotton-tipped applicators) can exacerbate both types.
This photo shows a swollen pinna and inflammation of the outer ear and ear canal in a patient with acute otitis externa (external otitis, or swimmer's ear).
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
The diagnosis of chronic otitis externa is usually clinically evident, based on history and physical examination. Contact dermatitis-induced and aural eczematoid dermatitis are distinguished only by the presence of a known contact allergen (eg, use of earrings that contain nickel in contact dermatitis). Patch testing can help identify the allergens in patients suspected to have chronic otitis media caused by contact dermatitis.
General reference
1. Patel S, Owen GS, Vivas EX. Otitis Externa and Malignant Otitis Externa-for the Hospitalist/Internist. Med Clin North Am. 2026;110(1):137-149. doi:10.1016/j.mcna.2025.05.007
Treatment of Chronic Otitis Externa
Avoidance of triggers and/or irritants, including earrings, water, and cotton-tipped applicators
Usually topical glucocorticoids
Chronic otitis externa typically requires regular aural debridement, identification and treatment of underlying conditions, and avoidance of contact triggers (both irritants and allergens), and sometimes treatment with topical therapies (mainly glucocorticoids) (1, 2).
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 glucocorticoids (eg, 1% hydrocortisone cream or a more potent 0.1% betamethasone cream) can decrease inflammation and itching. Recalcitrant cases can be treated with a short course of an oral glucocorticoid (eg, prednisone).of the ear requires avoidance or withdrawal of allergic triggers, especially earrings. Trial and error may be needed to identify the offending agent. Topical glucocorticoids (eg, 1% hydrocortisone cream or a more potent 0.1% betamethasone cream) can decrease inflammation and itching. Recalcitrant cases can be treated with a short course of an oral glucocorticoid (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 glucocorticoids (eg, 0.1% betamethasone cream). Topical therapy with selenium disulfide shampoo can also be effective. If 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 glucocorticoids (eg, 0.1% betamethasone cream). Topical therapy with selenium disulfide shampoo can also be effective. Ifacute external otitis ensues, careful debridement of the ear canal and topical antibiotic/glucocorticoid therapy (eg, ciprofloxacin 0.3%/dexamethasone 0.1%) may be required. Potential irritants, including water, cotton swabs, and even hearing aids until the inflammation resolves, should be avoided.ensues, careful debridement of the ear canal and topical antibiotic/glucocorticoid therapy (eg, ciprofloxacin 0.3%/dexamethasone 0.1%) may be required. Potential irritants, including water, cotton swabs, and even hearing aids until the inflammation resolves, should be avoided.
Treatment references
1. Hajioff D, MacKeith S. Otitis externa. BMJ Clin Evid. 2015;2015:0510. Published 2015 Jun 15.
2. Kesser BW. Assessment and management of chronic otitis externa. Curr Opin Otolaryngol Head Neck Surg. 2011;19(5):341-347. doi:10.1097/MOO.0b013e328349a125
Drug Information for the Topic
