Dandruff In The Ear Canal; How To Treat An Itch That Can’t Be Scratched

Dandruff in the ear is a vexing problem that I like to describe as "The itch that can't be scratched". My dad had it when I was a kid. I fixed it for dad once I became a dermatologist - like the mouse that pulled the thorn out of the lion's paw - dad was grateful! I received a question from a reader about ear dandruff. I want to share my answer with you. 

Dear Dr. Bailey,

After many years, I now know that I have seborrheic dermatitis and it's in my ears as well as on my scalp, nose, eyebrows, and eyes (blepharitis). Through the years I have been prescribed various drops for my ears, and they are only temporarily effective.  Of all the body parts affected by my seborrheic dermatitis, the ear canals are the worst area to treat and they itch the worst.  Also, the dandruff started in my ears years before the other areas of the body. Do you know of anything that might help?  GW S.

Dear GW,

Dandruff in your ear canal can cause an absolutely insatiable itch that's impossible to reach! Patients are so appreciative when I fix it for them; it's one of those little things that really makes a big impact on someone's life.

Dandruff shampoo used to wash your ears helps relieve dandruff in the ear canal.

I've found that my patients usually experience relief when they use the recommendations that I published for crusty ears affected by seborrheic dermatitis. The trick is that they have to be sure to carry this treatment down into the opening of the ear canal. 

I have my patients use a baby wash cloth and dandruff shampoo to wash their ears. These wash cloths are thinner than normal wash cloths so it's possible to reach into the ear canal opening a little.  They leave the shampoo on the skin for 5 minutes in the shower before rinsing it off.  It's important to rinse all the shampoo off of the skin because shampoo residue is irritating. The dandruff shampoo that I find works best is my Foaming Zinc Cleanser. 

Often people with ear dandruff have scalp dandruff and Foaming Zinc is an excellent dandruff shampoo.

Clotrimazole treatment for dandruff in the ear

Following use of the dandruff shampoo cleanser and rinsing well, I then have my patients apply a very small amount of Lotrimin (clotrimazole) solution or cream, using a cotton tipped applicator or their fingertip, just into the opening of the ear canal.  (Cotton tipped applicators should not be inserted down into the ear canal!) 

The Lotrimin clotrimazole cream will melt down into the canal as it heats to body temperature. 

Can you use hydrocortisone cream in your ears for dandruff?

If the itch and inflammation does not begin to improve after about a week then we add a little 1% hydrocortisone cream or solution, applied twice a day after the Lotrimin clotrimazole.  If after about 6 to 8 weeks things are not improving then it's time to come back to see me and possibly for me to refer them to an ear/nose/throat doctor for an exam. Cortisone creams have side effects and if you get to the point of wanting to use cortisone in your ears you should consult your doctor first.

I recommend that my patients maintain control of their ear canal dandruff by using the dandruff shampoo indefinitely to wash, and by occasionally applying the Lotrimin the minute the itch begins to return. 

Hydrocortisone can be added too if needed.  The important point is to never let the dandruff get really bad again because it's much harder to regain control of a bad flare-up, than it is an early one.  I find that it's also important to control all the areas of skin involved with dandruff; when dandruff is active somewhere, other areas are more likely to 'misbehave' too. 

Dandruff in the ear canal needs special care 

Ear canals are tricky because they have a unique group of bacteria and yeast germs living in them and sometimes these germs play a role in the problem.  I've seen some interesting and unusual infections of the skin of the ear canal that required treatment with antibiotics. Because the germ population there is unusual, I often have to use antibiotics that I don't normally use for skin infections.

The take home message is that dandruff in the ear canal is more complex than dandruff on other areas on the skin. 

Sometime there's just no substitute for getting the help of a dermatologist or ear/nose/throat doctor for this really frustrating problem-and sometimes that doc needs to think outside the usually treatment options if the problem isn't improving.

Lastly, and very importantly, I tell my patients to try not to scratch down in the ear canal, even if the itch is intense. Scratching will break open the skin of the ear canal and increase the chances of this rash getting infected with those unusual bacteria and yeast.

Facial dandruff usually coexists as well and for that I have my patients use my Redness Relief Kit.  

To learn more about seborrheic dandruff in all its forms click here for my Dermatologist's Advice Pages for Seborrheic Dermatitis.  

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.