Gail Porter had recently gotten into the habit of leaving a pair of tiny costume jewelry earrings in her ears while she slept at night. They were flat, circular, and gold in color — and the Los Angeles–based entertainment lawyer believed they were gold-filled, not gold-plated.

That distinction was important to her because she knew that gold-plated jewelry (which has only a thin layer of gold on the exterior that can flake off easily, exposing the base metal underneath) might irritate her skin.

When Porter’s earlobes became red, swollen, itchy, and hot to the touch, she decided that the earrings were probably gold-plated after all and that she was having an allergic reaction to the metal inside, possibly nickel or cobalt.

The outer parts of her ears broke out into an itchy, scaly rash, too, as did the creases behind her ears — signs of the inflammatory skin condition atopic dermatitis.

Based on prior experience, Porter believes her allergic reaction to the earrings triggered the outbreak.

How Atopic Dermatitis Affects the Ears

The most common form of eczema, atopic dermatitis is caused by an overactive immune system that produces inflammation and causes the skin barrier to become dried out and irritated, according to the National Eczema Association (NEA). The noncontagious condition is typically associated with dry, rash-like, itchy symptoms on the face, neck, arms, hands, feet, ankles, insides of the elbows, and backs of the knees.

But any area of the skin can develop atopic dermatitis, including the ears, says JiaDe “Jeff” Yu, MD, a dermatologist and the director of the Contact and Occupational Dermatology Clinic at Massachusetts General Hospital in Boston.

Indeed, he adds, the outside ear can be especially vulnerable to atopic dermatitis because it dries out easily, unlike some areas of the body where there are more oil and sweat glands, including the armpits, groin, and scalp.

Symptoms are similar to what would occur elsewhere on the body: “Itching, scaling, and redness are by far the most common,” says Dr. Yu. The rash can look purple, dark brown, or an ashy gray or white color on darker skin tones, according to the Asthma and Allergy Foundation of America.

The rash may hurt, says Yu, “especially if scratching has led to open sores and a bacterial infection.”

What Triggers Ear Eczema?

As Porter learned, atopic dermatitis can be triggered by allergic contact dermatitis — when your skin has an allergic reaction to substances it touches. The metal in costume jewelry is a common cause, Yu says.

He adds that in-ear headphones, foam earplugs, and ear drops are other culprits, and the reaction can affect the ear canal.

Picking at or rubbing the skin in and around the ears can also trigger a flare-up. “It is best to avoid scratching and rubbing these areas,” says Peter Lio, MD, a Chicago-based dermatologist who is on the board and clinical advisory council of the NEA.

Like Yu, Dr. Lio points to dry skin as a possible cause. “Very few people moisturize around the ears, and this may also help explain why eczema is more likely,” he notes.

How to Avoid and Treat Atopic Dermatitis in the Ears

To minimize eczema flare-ups, Yu, who is also affiliated with the NEA, recommends the following:

Avoid costume jewelry or opt for styles made with metals that are unlikely to trigger an allergic reaction, such as surgical steel, titanium, gold, silver, or platinum.
Don’t wear headphones or earplugs for an extended period of time.
Minimize exposure to cold, dry air. Use a humidifier and earmuffs during cold-weather months.
Apply a thick emollient to ears, such as Vaseline, to help seal in moisture.

Doctors can perform a so-called patch test on an area of skin to see if a particular substance might cause an allergic reaction that could trigger an atopic dermatitis flare-up.

Physicians can also treat atopic dermatitis involving the ears with topical medications that suppress the immune response, such as the following:

Low- to medium-strength topical steroids, such as over-the-counter hydrocortisone cream
Topical calcineurin inhibitors
Topical PDE4 inhibitors
Topical JAK inhibitors

Treating atopic dermatitis in the ear area can be a challenge because the skin is delicate and sometimes hard to access, says Lio.

“If [the eczema] is just below and behind the ear, usually creams or ointments can work well in those areas,” Lio says. “If there are cuts or fissures, it can be better to use a greasy ointment that is less likely to sting than a cream or gel or liquid. Things get more difficult if the ear canal itself has eczema: Then we often use oil-based [steroid] ear drops to help get a bit inside and cool the inflammation and itch.”

As for nonprescription remedies, Gail Porter found that moisturizing her ears and face with an over-the-counter lotion that contained colloidal oatmeal brought relief. “I just started rubbing it on my ears, behind them, and on my face. The eczema’s pretty much almost gone now,” she says.

Her advice to others who are prone to atopic dermatitis: “Take your jewelry off every night. Don’t shower in it. Don’t sleep in it.”

Seborrheic Dermatitis Can Affect Ears — and Eyebrows, Too

If you are experiencing itching, scaling, and color changes on or in your ears, the problem may not be atopic dermatitis. You may be dealing with seborrheic dermatitis, also known as scalp eczema because it is most commonly found on the skin atop the head.

“Seborrheic dermatitis is a fancy term for dandruff. It can occur anywhere the skin is oil-rich, such as inside the ears and the ear canal. It less often involves the external ear,” says Yu. The crease behind the ears and even the eyebrows can be affected.

Heat, sweating, and the trapping of sweat and oils can all be factors in a seborrheic dermatitis outbreak, Yu adds.

The underlying cause of seborrheic dermatitis may be a genus of yeast-like fungi on the skin known as Malassezia. “It may be that the Malassezia eats the increased sebum and then the immune system reacts to the overgrowth of the yeast on the skin,” Lio says.

How to Treat and Prevent Seborrheic Dermatitis on the Ears and Eyebrows

Yu uses several types of medication to treat seborrheic dermatitis. “Generally, I try to reduce the Malassezia yeast with an [antifungal] cleanser of some sort, such as ketoconazole or ciclopirox. Then, I have patients use an anti-inflammatory topical preparation such as a corticosteroid, or a nonsteroidal agent such as a topical calcineurin inhibitor,” Yu says.

Antifungal creams are a treatment option as well, according to Yu.

You can head off seborrheic dermatitis flare-ups by “avoiding in-ear headphones in the summer and prophylactically [preventively] washing the skin with antidandruff shampoos,” Yu advises.

Following a regular skincare routine can help keep seborrheic dermatitis symptoms at bay, according to the NEA, which recommends washing affected areas each day with a gentle, 2 percent zinc pyrithione cleanser (Head & Shoulders and Selsun Blue are over-the-counter examples), followed by a moisturizer.

Daily shampooing is acceptable for people with seborrheic dermatitis who have naturally straight hair, according to an article published by Brownskin.net, a website founded by the Penn Medicine dermatologist Susan C. Taylor, MD. Individuals who have curly, tightly coiled, or straightened hair that is more fragile, dry, and prone to breakage — particularly Black women — should wash once or twice weekly, as directed by a doctor.

Gail Porter, who is Black and also has occasional bouts of seborrheic dermatitis on the scalp and behind her ears, says keeping her hair washed once or more a week has helped eliminate flakes and itchiness in both areas.

To avoid problems in the creases behind her ears, she is careful to dry that area thoroughly after each shampoo. “Don’t allow it to stay damp,” she cautions.