Ear eczema is a chronic recurrent allergic skin disease caused by serous inflammation of the epidermis and dermis. The main clinical symptoms are severe itching, burning, hyperemia, swelling, papulo-vesicular rash, followed by wet erosions, crusts, peeling and lichenification. The diagnosis is based on the results of an external examination and dermatoscopy, which, if necessary, are supplemented with allergy tests and biopsy. Antiallergic and hyposensitizing drugs, antibiotics, NSAIDs, glucocorticosteroids, anabolic hormones, corticosteroid ointments, acupuncture are used in the treatment process.
General information
Ear eczema is one of the most common dermatological diseases of this localization. In total, this pathology accounts for about 35% of all lesions of the skin of the ENT organs. Its prevalence ranges from 2.5-6 cases per 1,000 population. The disease occurs in all age groups – from 4 months to 75 years with a peak incidence in 35-45 years. With the exception of the seborrheic form, which men suffer more often, this disease is diagnosed with the same frequency in representatives of both sexes. Complications are relatively rare – no more than 15% of cases.
Causes
Pathology belongs to a number of polyethological. The greatest importance in the process of its development is assigned to the dysfunction of the nervous system, disruption of the endocrine glands, hypersensitivity of the body and genetic abnormalities. The tendency to this disease is observed in children with exudative-catarrhal diathesis. The provoking factors may be exogenous or endogenous influences or a combination of them. The most common of them are:
- Endocrine pathologies. Most often, a violation of the pituitary gland, adrenal glands, sex glands (testicles or ovaries) is detected. Diabetes mellitus and hypothyroidism are singled out separately, which affect another link of pathogenesis, becoming the cause of immune insufficiency.
- Immunodeficiency. Pathology can develop against the background of a violation of the immune system caused by severe vitamin deficiency, chronic stress, fatigue, prolonged use of cytostatic drugs or radiation therapy, the presence of cancer.
- External impact on the auricle. Constant mechanical friction, hypothermia, contact with chemicals – cosmetics, industrial chemicals – can provoke an eczema lesion of the auricle.
- The presence of chronic foci of infection. Chronic tonsillitis, otitis media, untreated carious teeth are sources of pathogenic microflora that can penetrate the skin of the auricle by hematogenic, lymphogenic or contact pathways.
Pathogenesis
In modern medicine, eczematous processes are interpreted as an abnormal immune reaction of type IV according to Jale and Coombs, which leads to inflammatory changes, a tendency to secondary infection. This phenomenon is based on four main factors: insufficient immunity, increased sensitivity of the body to certain substances, disruption of the central nervous system and hereditary predisposition. The existing insufficiency of the body’s defenses lies in the dysfunction of prostaglandins and cyclic nucleotides, which leads to a decrease in the activity of neutrophils, T-helpers and nonspecific protective factors, including phagocytosis.
In addition, there is a change in the ratio of immunoglobulins in the blood – a lack of IgM and excessive synthesis of IgG, IgE. The genetic component of the disease consists in the presence of a specific B-22 gene in the chromosomes according to the HLA system. Disruption of the nervous system is accompanied by increased vascular permeability and excessive sensitivity of smooth muscle fibers to inflammation due to hypertonicity of the parasympathetic part of the peripheral NS and dysregulation of the hypothalamus. Traumatic damage to regional nerve fibers also contributes to the development of this pathology. Against the background of infection penetration in such conditions, autoantibodies are synthesized that support chronic inflammation in the ear tissues.
Classification
Depending on the etiopathogenetic and clinical features, several forms of ear eczema can be distinguished. This makes it possible to differentiate pathology in more detail with other nosological units, to correctly select therapeutic schemes. Thus, the classification of the eczematous process of ear localization includes the following options:
- True or idiopathic. It is characterized by the development of frequent relapses provoked by any, even insignificant in their intensity, stimuli. Often the exact cause cannot be determined.
- Microbial. It is formed on the site of chronic purulent foci – in the area of previously received and infected wounds, trophic ulcers, scratches, chondroperichondritis. A special role is assigned to chronic purulent otitis media, accompanied by suppuration.
- Mycotic. Develops against the background of hypersensitivity of the body to fungal antigens. The most common causes include ringworm, candidiasis of the outer ear and other forms of mycotic lesions of this area.
- Seborrheic. It occurs among patients suffering from seborrhea, is often a marker of HIV infection and AIDS. In addition to the skin of the auricle, other areas of the body rich in sebaceous glands are affected: the scalp, the interscapular region, the nasolabial fold, etc.
- Professional or contact. It is typical for people with hypersensitivity to substances with which they are forced to constantly come into contact at work. These are often chromium and nickel salts, artificial dyes, formaldehyde, and various resins.
Symptoms
Despite the presence of different forms of the disease, all variants of pathology have a typical sequence of clinical symptoms, including the following stages: erythematous papulo-vesicular, weeping and cortical. The beginning is usually acute. The primary manifestations are severe hyperemia, swelling, unbearable itching, burning, rarely pain.
Over time, a skin rash appears on their background in the form of papules and vesicles filled with serous fluid. After opening, they leave behind small wet erosions of the “serous well” type – the most characteristic symptom of eczema. During the healing process, gray-yellow crusts are formed, peeling, excoriation and lichenification appear, itching gradually subsides. Then the process goes from acute to chronic, which can last for years without proper treatment.
Idiophatic ear eczema is characterized by symmetry, the absence of clear boundaries of hyperemia and the formation of secondary depigmented spots on the skin. Clinical features of microbial eczema are the appearance of an itchy area of redness and swelling with a clear, pronounced contour; rejection of the stratum corneum of the skin on the periphery; the formation of a large number of purulent crusts completely covering healthy skin and small pustules in adjacent areas. With the microbial variant, the classic signs of a fungal disease and an eczematous process are combined. The seborrheic form is manifested by plaques, miliary papules of yellowish or brown color, merging with each other in the form of a ring or “garland”.
Complications
The most common complication of ear eczema is associated with the secondary attachment of bacterial flora by infection of combs or erosions. This leads to the development of impetigo or furunculosis, accompanied by a general intoxication syndrome. Erythroderma, regional lymphadenitis and lymphangitis occur less frequently. When the auditory canal is affected, its lumen may narrow with the formation of stricture or complete atresia. With a long, often recurrent course, the disease can transform into neurodermatitis.
Diagnostics
Diagnosis of ear eczema is not difficult for an experienced specialist. The diagnosis is established by the attending otolaryngologist or dermatovenerologist on the basis of anamnestic information, complaints and a specific clinical picture. During the survey, special attention is paid to concomitant endocrine pathologies, immune deficiency, working conditions and the presence of allergic diseases. The sequence of the development of the existing symptoms, the previously carried out treatment is determined. Further diagnostic program includes the following methods of examination:
- Visual inspection. External manifestations depend on the stage of the disease, may include sharp, limited hyperemia, vesicular-papular rash, wet erosions or crusts of various nature.
- Dermatoscopy. With a small magnification of the dermatoscope (10), an uneven focal distribution of blood vessels in the form of characteristic dots, peeling or crusts is determined.
- Otoscopy. It is used for signs of involvement in the process of the auditory canal. Visual changes consist in bran-like peeling. The inflammation is mild or absent. Characteristic wetness is observed only with strong combing.
- Allergy tests. They are used to determine substances to which there is an increased sensitivity in the patient. The study is most informative for professional and idiopathic eczema, as it allows you to detect the trigger.
- Skin biopsy. It is prescribed if it is impossible to clearly differentiate the eczematous process from other dermatological pathologies, especially at the erythematous stage of development.
Ear eczema treatment
Treatment of the disease is complex, depends on the form and severity, usually consists of systemic and local therapy. The main role is played by pharmacological agents, physiotherapy procedures and spa therapy are less often used. In parallel, the treatment of concomitant pathologies that contribute to the development of eczema is carried out. With an eczematous lesion of the skin of the outer ear , the following therapeutic measures are indicated:
- Systemic drugs. Hyposensitizing and antihistamines, tranquilizers and neuroleptics, vitamin complexes, immunomodulators and NSAIDs are used to combat allergic reactions. In severe cases, small doses of glucocorticosteroids are prescribed in combination with anabolic steroid hormones. In order to prevent secondary infection and therapy of the microbial form, antibacterial agents are used.
- External treatment. Gauze bandages soaked in vegetable oil are used to remove crusts and exfoliated skin. At the wet stage, cooling lotions from solutions of boric acid, silver nitrate or resorcinol are shown, after its cupping – corticosteroid ointments, keratoplastic preparations. With the microbial form of eczema, aniline dyes and ointments based on antibiotics are prescribed.
- Physiotherapy and spa therapy. During the transition of the disease to the chronic stage, it is advisable to use hydrogen sulfide, radon baths. With severe itching, acupuncture is indicated, and against the background of pronounced infiltration and lichenization – applications with ozokerite and paraffin, therapeutic mud. If the effectiveness of all the above-mentioned means is low, X-ray therapy is used.
Prognosis and prevention
The prognosis for life is favorable, for recovery – largely depends on the ability to eliminate the influence of etiological factors and correct violations of internal organs and systems. With a modern, properly selected treatment of the acute form of the disease, full recovery occurs on the 20th-25th day. The exception is idiopathic eczema, the therapy of which is difficult. Preventive measures include compliance with the rules of personal hygiene, restriction of contact with allergens (food or chemicals), early treatment of pyoderma, correction of existing systemic pathologies and immunodeficiency conditions.
