Psoriasis and the Ear

Psoriasis is a common skin disease that affects about five per cent of the population in the UK. It takes many forms. As well as affecting the skin anywhere in the body - including on the scalp and inside the ears, psoriasis can cause problems with the nails and fingers, all of the joints and within the spine. Psoriatic arthritis only occurs in a small proportion of people with psoriasis but it can be very disabling.

What Causes Psoriasis?

Psoriasis is not a true autoimmune disease in the same way that rheumatoid arthritis (RA) is. In RA, the body reacts against a foreign antigen with a similar shape to a protein within the joints, attacking the body’s own tissue. In psoriasis, there does not seem to be an antigen from outside the body that triggers the process that leads to skin flaking. Instead, the disease may have a genetic component, or other environmental causes that have not yet been identified.

Whatever the cause, in people with psoriasis, key immune cells travel through the lower layers of the skin into the upper dermis, causing a generalised immune stimulation. This causes the skin cells to divide much faster than normal and they literally end up falling over each other and spilling off the surface. This is why skin plaques in people with psoriasis are raised, pink and usually produce a lot of dry, flaky skin.

Psoriasis in the Ear

Psoriasis can flare up anywhere on the body but some sites are often more affected than others. The elbows and knees are common places for pink psoriatic plaques because they get a lot of wear and tear. The scalp, for reasons we don’t really understand, is also often affected and can be difficult to treat. The white skin flakes from the psoriasis look like very bad dandruff and can lead to a lot of embarrassment. Putting moisturises and skin emollients into the scalp can be very difficult, and the main treatment is regular hair washing with a medicated or anti-fungal shampoo and treatment with a scalp lotion containing corticosteroids when the inflammation is particularly bad.

Many people with scalp psoriasis also experience skin problems inside their ears. The same plaques occur here, right up to the ear drum and the excess, flaky skin that is produced can clog up the ear canal, leading to an increased risk of ear infection. This can cause temporary hearing problems and even hearing loss.

Itching and Psoriasis

One of the worst aspects of psoriasis, according to those who have it, is that the changes in the skin lead to intense itching which causes an itch-scratch cycle. The build up of skin cells traps sweat and debris, which irritates the underlying layer of skin and causes nerve endings to fire continuously, leading to a creeping, prickling sensation that is difficult to ignore. Itching is probably a response by the body to encourage the dead skin cells to be removed but scratching can break the surface of the skin. This can lead to infection with bacteria or fungi anywhere on affected skin but is a particular problem in the narrow ear canal. People with ear psoriasis report being able to peel away strips of skin when the condition is flaring up and often say they cannot leave their ears alone.

Treating Ear Psoriasis

The condition is much better if you can leave the ears well alone but the itching and skin build up makes this very difficult for most people. Using a cotton bud with a gentle cleansing mineral oil can be helpful as this removes scaly skin and also moisturises and soothes at the same time. Corticosteroid solutions suitable for scalp use can also be applied sparingly in the ear to reduce itching and stop scratching and pulling at the skin.

Any ear infections need to be treated promptly, and clearing the ear canal is best left to a doctor or practice nurse, who will be able to treat tender ears without risking damage to the ear drum.