Dermatological Disorders of External Ear Accompanied by Pruritus: Classification, Clinical Manifestations, Diagnosis, Treatment

Dermatological disorders of the external ear accompanied by pruritus — collectively referred to as pruritic dermatoses — comprise a group of inflammatory skin conditions affecting the auricle and external auditory canal, with intense itching as the primary symptom. These disorders significantly impair patient’s quality of life and require a comprehensive treatment approach, as they often reflect underlying systemic dysfunction.

In clinical practice, the following forms of pruritic dermatoses of the external ear are recognized:

• Eczema of external auditory canal;
• Auricular eczema;
• Contact dermatitis.

Etiology

The causes of auricular and external auditory canal eczema are multifactorial. Typically, the underlying trigger is a systemic condition, such as:

• Diabetes mellitus;
• Thyroid disorders;
• Autoimmune diseases;
• Gout;
• Atopic dermatitis.

These, in turn, can often coexist with various ear disorders (such as recurrent chronic suppurative otitis media or intermittent skin trauma), which can exacerbate the pathological process.

Skin irritants play a key role in the development of contact (allergic) dermatitis, including:

• Beauty products;
• Jewelry;
• Hearing aids;
• Eyeglass frames;
• Occupational hazards (dust or shavings).

Anatomy

External Ear Eczema

Eczema is a long-lasting, relapsing, cyclical skin disorder. It arises from immunologic dysfunction.

The chronic phase is characterized by dry, flaky skin and lichenification (i.e., thickened and leathery skin). Additionally, the ear canal may become blocked by keratinized epidermis.

In the acute phase, vesicular rash secondary to hyperemia may develop. Vesicles tend to rupture and ooze serous fluid, leading to weeping. Subsequently, a crust forms over the lesions. Areas affected by eczema, which are exacerbated by scratching, can become infected. In this case, vesicles evolve into pustules that can also rupture and shed purulent fluid; the lesions are then covered by purulent crusts.

Allergic Contact Dermatitis of External Ear

Allergic contact dermatitis is a delayed-type hypersensitivity reaction (type IV).

This condition involves pathological changes in the skin induced by either a prolonged sensitization or reexposure to an allergen.

Lesions that directly contact an allergen can develop vesicular rash and bullae filled with serous or hemorrhagic fluid. The skin is hyperemic and infiltrated. Ruptured vesicles and bullae contribute to crusting and scaling.

Clinical presentation

In the chronic phase, eczema of the auricle and the external auditory canal is identified solely by changes in skin appearance; other clinical manifestations are uncommon.

Symptoms of eczema in the acute phase:

• Marked pruritus;
• Exfoliative conditions;
• Weeping (serous fluid excretion);
• Crusting.

Secondary infection can lead to purulent discharge, narrowing, and tenderness of the ear canal, which can hinder the diagnosis.

Note that eczema typically manifests with multiple lesions on the skin in the region of the radiocarpal joints, cubital fossae, face, and scalp.

Symptoms of allergic contact dermatitis:

• Pathological changes in the skin area that comes into contact with an allergen;
• Marked tenderness;
• Pruritus (this sign is of a lesser concern).

Diagnosis of External Ear Dermatoses

Diagnosis is based on a patient’s medical history and physical examination.

General symptoms such as fever, chills, and signs of intoxication are rare, as well as deep auricular (ear cartilage) lesions and morphological changes.

Allergy testing may sometimes be utilized to diagnose the disorder and identify the underlying cause.

Differential diagnosis may be necessary when a secondary bacterial infection develops, in order to rule out acute otitis externa, perichondritis, acute suppurative otitis media, and other dermatitis types (including psoriasis and seborrhoea).

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Treatment of External Ear Eczema and Contact Dermatitis

This category of disorders is typically subject to conservative treatment on an outpatient basis.

Contact dermatitis management can only be successful when the root cause is eliminated. Therefore, it is important to avoid any triggers, such as water contact and mechanical skin injuries, while the underlying extraorgan disease should be curtailed.

Please note that contact dermatitis management can only be successful when the root cause is eliminated. It is essential to prevent water exposure and mechanical trauma to the skin.

If a bacterial infection has developed, antibacterial ointments should be applied locally, any lesions should be regularly treated with antiseptic solutions.

Once the inflammation is under control, ointments containing glucocorticosteroids (GCS) and salicylic acid are typically recommended, with the latter having a keratolytic and regenerative effect. Oral antihistamines can help alleviate symptoms.

In the chronic phase, the skin should be regularly moisturized with liniments, while prolonged contact with water should be avoided. Physiotherapy, including UV exposure and ultra-high frequency (UHF) treatments, has been shown to contribute to positive outcomes.