Eczema of the external ear is an allergic inflammation of the auricle, external auditory canal, and peripheral skin, is characterized by pruritus, polymorphic rash, and recurrence, mostly in children, and is generally divided into acute eczema and chronic eczema.
Etiology
Etiology and pathogenesis of eczema of the external ear are not yet fully understood, and may be associated with allergic reactions, mental factors, and neurological dysfunction. Drugs, woolen fabrics, cosmetics, hair sprays, fishes, shrimps, and milk can be allergens. Long-term pus stimulation in the external auditory canal can also induce the disease.
Clinical manifestations
Acute eczema presents severe pruritus, accompanied by burning sensation, mainly in infants and young children. The erythema or miliary papules on the skin can develop into vesicles; after rupture, yellow watery fluid may flow out; the epidermis is eroded and sometimes covered with yellow scabs. If secondary infection occurs due to scratches, the lesion may expand, the exudation may increase, and small superficial ulcers may also occur.
Chronic eczema is manifested by pruritus, thickening of the outer ear skin, epidermal desquamation, cracks, and scabs, local pigmentation, and rough surface, as well as stenosis of the external auditory canal. If the tympanic membrane is involved, mild conductive hearing loss and tinnitus may occur.
Figure 1 Eczema of the external ear
Treatment
Allergens should be avoided. If caused by purulent otitis media, the external auditory canal should be cleaned, and anti-inflammatory treatment should be conducted.
Rinse with soap or hot water, irritating drugs, scratches, and ear picking should be avoided.
In patients with more exudation, wet compression with 3% boric acid solution or 15% zinc oxide solution can be used. In patients with less or no exudation, 1% - 2% gentian violet solution, prednisone cream or ointment, and zinc oxide oil or paste can be applied. If there are dry scabs, 3% hydrogen peroxide solution can be used to clean the skin, and the above-mentioned cream or ointment can be used.
In patients with thickened or cracked skin, 10% - 15% silver nitrate can be applied, and 70% ethanol solution can be used to clean the external auditory canal.
Anti-allergic drugs such as chlorpheniramine and loratadine can be orally administered. In severe patients, glucocorticoids such as dexamethasone can be administered. In case of secondary infection, local and systemic antibiotics can be used. When there is excessive exudation, rehydration and vitamin C supplementation are required.