Treatment of Psoriasis Affecting the Ears

First-Line Treatments

The British National Formulary recommends moderately potent topical corticosteroids (grade III) for ear psoriasis to relieve symptoms while minimizing side effects 1, 2
Emollients should be used as adjunctive therapy to reduce itching, scaling, and help maintain skin barrier function, according to the American Academy of Dermatology 3
Apply emollients 1-3 times daily to affected areas to improve hydration and reduce symptoms, as suggested by the American Academy of Dermatology 3

Low concentration coal tar preparations (starting with 0.5-1.0% crude coal tar in petroleum jelly) can be used if corticosteroids are ineffective, with concentration gradually increased to a maximum of 10%, as recommended by the British Medical Journal 4
Vitamin D analogues (calcipotriene) can be used alone or in combination with corticosteroids for better efficacy, according to the Journal of the American Academy of Dermatology 5

The ear is considered a sensitive and vulnerable area, requiring careful selection of treatment options, as stated by the Journal of the American Academy of Dermatology 6
Avoid high-potency (class I or II) corticosteroids for long-term use in the ear area due to increased risk of skin atrophy, as warned by the British Medical Journal 4, 2
Short-contact therapy approaches may be beneficial to minimize side effects while maintaining efficacy, as suggested by the British Medical Journal 2

For mild ear psoriasis, start with moderately potent (class III) topical corticosteroid once daily, as recommended by the British Medical Journal 1
Add emollients 1-3 times daily, as suggested by the American Academy of Dermatology 3
Use for 2-4 weeks, then reassess, as recommended by the British Medical Journal 2
If inadequate response, consider combination therapy with vitamin D analogue (morning) and corticosteroid (evening), as recommended by the Journal of the American Academy of Dermatology 5
Or try low concentration coal tar preparations, as suggested by the British Medical Journal 4

Regular clinical review is essential when using topical corticosteroids, as recommended by the British Medical Journal 4
No unsupervised repeat prescriptions should be provided, as warned by the British Medical Journal 4
Periods where alternative treatments are employed should be incorporated into the treatment plan, as suggested by the British Medical Journal 4
For patients with more than 5% body surface area affected or with significant quality of life impact, consider systemic therapy, as recommended by the Annals of the Rheumatic Diseases 7

For pregnant patients, emollients are considered safe and should be first-line treatment, as suggested by the American Academy of Dermatology 3
Ear psoriasis can significantly impact quality of life and may be part of more widespread disease requiring comprehensive assessment and management, as stated by the Journal of the American Academy of Dermatology and the Annals of the Rheumatic Diseases 6, 7