Seborrheic Dermatitis Ear Treatment and Diagnosis Guide

This article examines seborrheic dermatitis effecting the ears.

Discussion includes:

• An introduction to seborrheic dermatitis (what causes it and why some of us are more susceptible than others)
• It’s unique characteristics in and around the ears
• A thorough review of proven treatments (both conventional and natural/holistic)

For the most part, every attempt is made to stick to findings and treatments with substantial scientific evidence (references available). However, some reader suggested tips are also included for a more complete picture.

By the time your done reading you should know:

You’re likely to have some questions along the way. In this case, feel free to use the comments section as you see fit; will try my best to follow-up in a timely manner.

Brief Introduction to Seborrheic Dermatitis

For the most part, seborrheic dermatitis is a considered to be a chronic skin condition that is caused by the Malassezia yeast.

The Malassezia are lipid-dependent yeast which are present on the skin of almost all humans [1]. For most people, these yeasts cause absolutely no issues, but in certain susceptible individuals, they are believed to trigger various skin symptoms and conditions; one of which is seborrheic dermatitis [2, 3].

Though seborrheic dermatitis has long been considered to be caused by malassezia, more recent evidence reveals the relationship is a bit more complex. At this time, the following is the best explanation we have:

• Increased malassezia -> irritant by-products -> skin barrier damage -> irritation & symptoms

Apart from the Malassezia, other factors have also been put forward by researchers:

• Altered-immune response – reduced T-helper cell numbers [4]
• Difference in malassezia activity – in individuals affected by seborrheic dermatitis, they produce select skin irritants which are not seen in non-affected individuals [5]
• Abnormal oxidative stress – a relationship between the oxidative stress index and seborrheic dermatitis severity has been noted [6, 7]
• Nutritional status – lowered vitamin E levels and abnormal fatty acid balance [8]
• Shift in overall skin microbiota – recent evidence suggests that the bacterial flora of the skin has a more direct relationship to seborrheic dermatitis than malassezia [9, 10, 11]

But really, this is just the tip of the iceberg.

Unique Characteristics of Seborrheic Dermatitis of the Ears

While seborrheic dermatitis can affect various areas of skin, it’s important to understand what makes skin issues unique (particularly if your issues are isolated here). To understanding the nuances, you become better aware of how you should approach treatment.

Why Seborrheic Dermatitis Affects the Ears

The skin environment differs throughout the body; some areas are moist, others are dry, and a select few are oily. The ears fall into the oily category. Here the number of sebaceous glands is fairly high ad the skin depends on a lipid-rich environment for adequate protection from the outside environment.

Since Malassezia yeast thrive in such a lipid-rich environment, the ears become a susceptible area. And chances are, that if your ears are affected, so is your scalp, nasal region, eyebrows, forehead, chin, and even possibly your lower back.

Severe Cases – Issues with Treatment Towards the Ear Canal

Seborrheic dermatitis can differ in severity. In some cases, seborrheic dermatitis symptoms can affect the area of skin deeper into the ear (towards the ear canal). In such cases, it’s best to seek medical attention, as many treatments discussed here may not be appropriate.

If you’ve tried everything that the medical professional has suggested and are still not seeing any progress, make plans to seek the opinion of other medical professionals in your area. Getting a second, third, fourth, and even fifth opinion can help improve the accuracy of diagnosis and increase your chances for treatment success.

Medicated Treatments

Medicated treatments usually rely on an active anti-fungal agent to suppress the Malassezia yeast (which is believed to be an integral part of seborrheic dermatitis symptom progression). Many of these anti-fungal agents have been around for several decades and have an impressive amount of literature to back-up their effectiveness. From personal experience, results may vary.

Anti-Fungal Shampoos

Shampoos are meant for the head, however, this hasn’t kept people from using them elsewhere. I’ve even been recommended to use head and shoulders on my face by a dermatologist (to control facial seborrheic dermatitis).

To use an anti-dandruff shampoo or conditioner for seborrheic dermatitis in your ears, simply apply a pea-sized amount to the ear. Once applied, leave it on for 3-5 minutes and rinse off with water. Simple as that.

Common Anti-Dandruff Shampoos

The most commonly used shampoos for seborrheic dermatitis are:

• Head and Shoulders (zinc pyrithione)
• Neutrogena T-Gel (coal tar)
• Nizoral (ketoconazole)
• Selsun Blue (selenium sulfide)
• JASON Natural Dandruff Relief (sulfur + salicylic acid)

For me, I’ve found that anti-dandruff conditioners work much better for fighting seborrheic dermatitis in the ears. Typically, conditioners are more moisturizing then shampoos. Since your not really aiming to clean your ear, but simply to control seborrheic dermatitis, this seems to be a good alternative.

My experience with using anti-fungal shampoos has been very positive, especially, for the ears. It seems that the skin inside the ear is much less sensitive than regular facial skin. Using anti-fungal shampoos or conditioners on my facial skin would often leave it feeling unhealthy and overly bare. However, inside and behind the ears, this was not a problem. Though with time, I decided to steer away from all the commercial anti-fungal products. My opinion is that symbiosis is the way to go.

Anti-Fungal Creams, Lotions, and Soaps

There are products currently on the market that contain the same active ingredients discussed in the shampoo section above. However, these products come in the form of creams, lotions, or sprays aimed at other areas of the body. The directions for each cream should be listed on the packaging.

Most Common Anti-Fungal Products

Here are the most popular products available (most of which, I’ve personally tried):

• Noble Formula Zinc Cream (zinc pyrithione) – tried this
• DermaZinc Cream (zinc pyrithione)
• Noble Formula Bar Soap (zinc pyrithione) – tried this
• DermaZinc Soap (zinc pyrithione)
• SAL3 Cleansing Bar (sulfur + salicylic acid) – tried this
• MG217 Medicated Tar (coal tar)
• Soap Works Coal Tar Bar Soap (coal tar)

In addition to this list, people have reported using jock itch creams. Plus, there are also many prescription anti-fungal creams available. For these, simply talk your doctor.

My experience with many of these products has been the same as with the anti-fungal shampoos. Overall they worked really well for controlling seborrheic dermatitis in the ears.

The biggest benefit was that they were designed for general use (as compared to shampoos). The creams and lotions were much more suited for applying and leaving on. However, some products were far too greasy for my liking. In the end, I just didn’t feel like this category of products was a good long-term solution for me.

Nystatin – Anti-fungal Cream

Nystatin is the first commercial anti-fungal agent [12]. It has been shown to be effective at suppressing malassezia yeast, but its use declined as nystatin resistant malassezia strains were identified [3].

Nonetheless, a long-term community member by the name of Joakim emailed me his method and described that nystatin worked when other options failed. Since then, various other readers have also confirmed this in the comments section of that article.

In most countries, nystatin is available only through prescription. It is a well documented and widely used anti-fungal agent.

Natural Treatments

This section includes some possible natural treatments worth trying. The biggest downside is the majority of natural treatments are based primarily on anecdotal evidence and/or limited medical findings. Nonetheless, natural approaches will always have their place and many people naturally lean towards them (including myself).

Apple Cider Vinegar

One of the most popular natural treatments for seborrheic dermatitis in the ears is apple cider vinegar. From my research, it seems that the main constituent responsible for this is the malic acid. Anecdotal reports suggest malic acid can control various yeasts and fungi. But further investigation reveals it may be the pH-lowering effects that provide the symptom relief [13].

How to Use Apple Cider Vinegar In and Behind the Ears

To use apple cider vinegar for the ears simply mix it with water using a 1 to 1 ratio. Once mixed, use a cotton cloth-pad to wipe and cleanse the ears with this mixture. It’s typically recommended to leave the apple cider vinegar on the skin for 10-15 minutes. This allows it to really soak in and do its job.

When first starting out, it’s a good idea to try with a small area of skin and see how it reacts. Another thing you can do is start with a small concentration. Once your skin adapts, gradually increase the concentration to a more desirable one.

Some people swear by using pure apple cider vinegar without diluting it. This is especially a good option for the ears as the skin is typically less sensitive. However, pure apple cider vinegar tends to be quite strong, especially, if your skin is not yet used to the acidity. Again it’s probably a good idea to start off slow and build up to using it pure.

Tea Tree Oil

One of the most famous essential oils out there. A quick peek through the natural beauty care section at the supermarket will uncover a wide variety of tea tree based anti-dandruff shampoos. Clearly, this method has some weight behind it.

Tea tree oil is an essential oil extracted from the leaves of the narrow-leaved paperbark tree. The oil has been shown to have diverse antimicrobial properties. The reason why it has been shown to help with seborrheic dermatitis is that it can destroy the Malassezia yeast which is believed to cause it [14].

How to Use Tea Tree Oil

The tea tree oil alone is quite strong and can easily irritate the skin. The most common method to use tea tree oil is mixing it with a carrier oil. A carrier oil basically dilutes the tea tree oil, making it suitable for topical application. The most popular carrier oils are coconut oil, olive oil, and hemp seed oil. A concentration of about 5 drops of tea tree oil per teaspoon of carrier oil is the most common. However, I’ve found this number to vary from person to person.

Once you have mixed up a tea tree oil solution, simply dab it on the effect skin on your ears. Leave this mixture on and allow to soak in for maximal effectiveness. Some people prefer to wash it off, while others leave it on.

Raw (Crude) Honey

Raw honey is another extremely popular natural remedy for seborrheic dermatitis. And much of this popularity is most likely related to a small scale 2001 study that actually demonstrated and documented its effectiveness [15].

How to Use Raw (Crude) Honey for the Ears

The most common way to use raw honey to fight seborrheic dermatitis is by mixing with equal parts water. This mixture is then applied to the skin, left to do its thing for ~3 hours, and then rinsed off with water.

For me, it wasn’t really a workable approach for the ears. I found that I often forget about the honey and would sticky up my phone. So instead I would just wash the ears with the honey and simply rinse off right away. If I was having a shower, I’d apply it beforehand and rinse off towards the end of the shower.

Overall I felt like this was quite an effective solution. However, I haven’t used this method for quite a while simply because the method I go over next, has been easier.

Dietary Changes – Avoiding Certain Foods

This specific seborrheic dermatitis treatment approach has quite a large number of variables, making it hard to pinpoint any specific foods that can cause seborrheic dermatitis.

Everyone’s genetics are different. People from different parts of the world grow up on different diets. From my point of view, the biggest mistake people make is believing many of the myths going around the internet.

For the longest period of time, I was convinced that gluten was the cause of my seborrheic dermatitis. After attempting to go gluten free for almost a whole year, I came to the conclusion that it definitely was not the cause of my issues. Additionally, I found it a huge struggle to avoid products containing gluten.

Commonly Discussed Items – Everybody is Different!

The experiences of people all over the internet do point to a few key dietary irritants that keep coming up. These are dairy, gluten, fruit, and night-shades. However, I really believe that specifically outlined foods like this can lead to issues.

The best thing to do is simply keep a log book. Stop trying to over-think things. Listen to your body and see what it’s telling you and not what others on the people are telling you. Perhaps by learning to listen to your body, you will also get rid of that pesky seborrheic dermatitis in your ears.

Alternate Approaches

This section discusses two other approaches that I’ve personally used and have found helpful. Both approaches have gained a substantial following on this website and their respective posts have long comment threads with additional discussion that readers may find useful.

Barrier Repair

Treatments aiming to improve the skin’s own barrier are usually not mentioned in the medical texts on the subject. However, since a major component of seborrheic dermatitis is directly related to abnormal barrier function [16], this treatment approach surely deserves more attention.

For starters, reducing the number of irritants can be helpful and switching to a more gentle skin cleansing regimen is recommended.

Some general tips include:

• Switch from soaps to gentle cleansers designed for sensitive skin
• Reduce the frequency of skin washing
• Stick to cold water
• Avoid touching/scratching the skin

Generally, once you’ve reduced external irritation (in the case of seborrheic dermatitis, mainly attributed to the malassezia yeasts), your skin should slowly begin to stabilize. But further external assistance can be helpful and reduce recovery time.

This is where barrier repair formulations come-in. Barrier repair formulations come in a variety of options (creams, lotions, ointments), but all have one primary goal in mind: to reduce moisture loss and reduce skin sensitivity.

Though focusing on barrier stability (as opposed to reducing malassezia activity) is not an official recognized approach. Some recent case studies suggest that it may hold significant potential moving forward [17, 18].

Discover what you can do to repair a damaged skin barrier

The 8 Components of Healthy Skin - Improving Barrier Function

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Skin Lipid Augmentation

As discussed at the beginning of this article, malassezia yeast depend on lipids as a food source. However, some specific lipids have shown to suppress malassezia activity [19].

A potential future direction for seborrheic dermatitis treatment would be to augment/modify the sebums lipid composition in a way that reduces malassezia activity while also improving skin barrier function. In theory, such a one-two approach could drive quick results and be well tolerated.

Authors History with Seborrheic Dermatitis in the Ears

Initially, my seborrheic dermatitis started on my scalp. This was long before I knew that it was even called seborrheic dermatitis. At that time I simply thought its name was dandruff (which technically is seborrheic dermatitis of the scalp). Then one day I noticed a strange irritation on the inside of my nasal folds.

Long story short, this irritation spread and spread. The dermatologist prescribed anti-biotic and anti-fungal creams did little to stop the spreading. It’s not that they didn’t work, it’s just that they either worked only initially or were not suitable for long-term use. About a year later I had a real problem on my hands. My facial skin was splotchy, inflamed, and covered in flaky patches.

Fast forward 3 years and countless hours of researching seborrheic dermatitis, I now have things under control. At least, for the most part. The area which has kind of stuck around, lingering in the back, has been my ears. However, seborrheic dermatitis in my ears now is different. It’s much milder and the skin doesn’t appear to be damaged. The only real issue is that flaking sometimes still occurs inside the ear. Luckily it’s not overly noticeable.

This article is essentially a review of many of the treatment options that I’ve attempted during my time dealing with seborrheic dermatitis. While I do try my best to keep the post up to date with new information that comes my way, the most active section of the websit remains the SD owner’s manual, which is my attempt to gather everything in one place.

Review of Treatments Discussed

As you can probably tell by now, there are quite a lot of options for treating seborrheic dermatitis in the ears. Depending on your preferences, some may prefer a more natural approach while others are solely interested in the treatment effectiveness.

Medical treatments include:

• Anti-dandruff shampoos
• Anti-dandruff conditioners
• Anti-fungal soap
• Anti-fungal creams

Anti-fungals currently approved by the FDA for seborrheic dermatitis treatment are:

• Pyrithione zinc – 0.3 to 2% in wash-off formulas
• Pyrithione zinc – 0.1 to 0.25% in leave-on products
• Salicylic acid – 1.8 to 3%
• Selenium sulfide – 1%
• Sulfur – 2 to 5%
• Coal Tar – 0.5 to 5%

Natural treatments include:

• Apple cider vinegar
• Tea tree oil
• Raw honey

Alternate approaches to consider:

• Barrier repair
• Skin lipid augmentation

Whatever approach you decide to take, it’s easy to forget the importance of correct diagnosis. Without a correct diagnosis, your efforts are unlikely to prove worthwhile. Different skin conditions often require completely different approaches.

Summary and Conclusion

This article was an attempt to provide a comprehensive review of why some of us are unfortunate to experience seborrheic dermatitis on the ears and possible ways we can deal with it.

Key points include:

In the end, hopefully, you found the information in this article relevant and useful. Most importantly, perhaps you may benefit from one of the treatment options presented and your seborrheic dermatitis issues become a thing of the past.

If you have any questions or want to share your own approach to seborrheic dermatitis ear treatment, feel free to drop a comment below.