Flaky skin in ears: causes and treatment

Where are the flakes, and what comes with them?

The visible outer ear, the fold behind the ear and the canal leading to the eardrum need different care. Look at the location, whether the skin itches or hurts, and whether there is fluid coming out. Also check for scaling on your scalp, eyebrows or beside your nose: seborrheic dermatitis often affects several of these areas together. These patterns help a clinician identify the cause; flakes alone do not identify it.134

How do you treat dry, flaky skin in ears?

For dry skin on the visible outer ear, use gentle skin care rather than treating the canal yourself. Skincare for the visible outer ear can be as basic as gentle cleansing and moisturizer, without promoting the ear to a second face.2

1. 1Wash the visible outer skin gently with warm, not hot, water and a mild, fragrance free, soap free cleanser. Keep cleanser out of the canal.
2. 2Apply an emollient, meaning a moisturizer that softens dry skin, to the outer skin after washing and whenever it feels dry. There is no need to reserve moisturizing for morning or night.
3. 3Remove likely irritants from contact with the area. Keep shampoo, conditioner and soap out of the ears, and consider whether hair products coincide with the irritation.
4. 4Leave the canal alone. Do not insert cotton buds, fingers or other tools to scrape out flakes.
5. 5If otitis externa is diagnosed, keep the ears dry during treatment. Avoid swimming and follow the prescribed ear treatment rather than extending an outer skin routine into the canal.

The skin barrier is the outer layer that keeps water in and helps keep irritants and bacteria out. Scrubbing and excessive cleansing can damage it further. Use the gentle outer skin routine consistently rather than repeatedly trying to remove every visible flake. A moisturizer supports dry skin, but an underlying inflammatory condition needs its own treatment.2

Which treatments need a diagnosis first?

For seborrheic dermatitis, medicated dandruff shampoos are a treatment option for flaking and dryness. Choose one labelled for dandruff or seborrheic dermatitis and follow its directions. Do not treat shampoo as an ear drop or assume scalp directions apply inside the canal. More severe seborrheic dermatitis can need prescription creams, ointments or lotions, including antifungal or anti inflammatory treatments.6

Eczema treatment includes avoiding the relevant irritant or allergen, moisturizing and, when needed, a prescribed topical steroid to reduce inflammation. Ointments generally suit dry eczema, while creams suit wet, weeping skin. These are general eczema principles, not instructions to put a steroid inside your ear. A clinician should choose the treatment and its application site.5

Ear canal treatment also depends on whether the eardrum is intact. Tell the clinician if you have a known perforation or ear tubes, because these change which drops are suitable. Do not assume an itch relieving ear product treats infection. EarCalm helps itching associated with otitis externa but is not a treatment for infection.4

What causes crusty, dry skin in ears?

Seborrheic dermatitis can cause flakes, crusting, cracks and oozing around or inside the ears. Dermatitis can also become wet and weepy rather than simply dry. Crusting does not automatically mean infection, but crusts with fluid or pus, increasing redness or pain warrant medical review. Inflammation can be less visibly red on darker skin, so do not use redness as the only sign that something is wrong.356

What causes flaky skin behind ears?

Seborrheic dermatitis commonly affects the skin behind the ears. Scalp psoriasis can also extend beyond the hairline and appear there. Contact dermatitis is another possibility where products or materials touch the skin; nickel in spectacle frames is one example of a contact allergen. If patches keep returning in the same place, identifying the trigger or condition is more useful than repeatedly changing moisturizers.567

How long does it take to improve?

With appropriate medication, otitis externa symptoms usually improve within a few days. Untreated cases can take several weeks, and chronic cases can persist for months or years. Seborrheic dermatitis is a long term condition that comes and goes but can be controlled with treatment. For either condition, persistent symptoms are a reason to reassess the treatment, not to clean more aggressively.16

When should you get your ears checked?

• Arrange a medical appointment for canal pain, discharge, hearing changes or suspected otitis externa.
• Get checked if self care does not help, or if patches develop crusts, pus or marked pain.
• Seek same day care for severe or uncontrolled pain, feeling unwell, swelling behind the ear, spreading swelling or redness onto the ear or face, or a canal swollen shut.
• Seek urgent assessment for severe ear symptoms with diabetes or a weakened immune system, because serious infection is more likely in these groups.
• Return for review if ear canal symptoms persist beyond two weeks despite treatment.

A clinician can examine the canal with an otoscope and review hearing aids, ear plugs, water exposure and products touching the area. An ear examination looks inside the canal, where a bathroom mirror's enthusiasm exceeds its qualifications. Recurrent or persistent problems can need an ear swab to identify infection, or patch testing to identify a contact allergy.15