Chronic ear pruritus

Chronic ear pruritus, itching of the ear that lasts longer than six weeks, is a common symptom with a wide differential diagnosis that can significantly impair the quality of life. It can arise from such primary dermatologic conditions as psoriasis, seborrheic dermatitis, contact dermatitis, atopic dermatitis, and lupus erythematosus, as well as such infestations as scabies and pediculosis capitis. Otolaryngologic causes-for example, otomycosis, chronic otitis externa, and temporomandibular joint disorders-may also lead to chronic ear pruritus. Systemic diseases, such as diabetes, hematologic malignancies, or chronic liver and kidney disorders, may manifest as generalized pruritus involving the ears, as well. Accurate diagnosis of the cause requires careful medical history taking and physical examination, with consideration of both local and systemic factors. Management depends on the underlying cause and may include topical corticosteroids, antifungals, calcineurin inhibitors, or systemic immunomodulators. Identifying and avoiding allergens, especially from jewelry or topical ear medications, is important when there is contact dermatitis. In patients with refractory or severe findings, newer therapies such as biologics and targeted immunologic agents may be useful.