What is Chronic ear Eczema?

Like the skin on the outside of the body, the skin inside the ear canal can become inflamed and irritated.

This can be due to:

  • A bacterium or fungus growing on the skin surface
  • An irritant substance which comes into contact with the ear canal (for example, some soaps or chlorinated water)
  • Physical irritation of the skin, e.g. by itching or poking objects into the ear canal, including use of cotton buds
  • A sensitivity in the body’s immune system (called Atopic Eczema)

Healthy skin produces a steady supply of cells which harden and die as they reach the skin surface, providing a protective layer. These are then naturally shed from the surface. Ear wax contains a mixture of these dead cells and protective oils made by the skin. In eczema, inflammation causes the top layers of the skin to become leaky and dry out. Cracks in the skin surface can allow bacteria to invade the protective barrier, which can cause further irritation. Antibiotic ear drops which kill bacteria in the ear are useful for a short-term ear infection, when the ear is sore or has a smelly discharge. However, prolonged use may result in the skin becoming sensitive to the antibiotic, or allow other bugs (such as fungi) to grow in their place. For ears which are itchy and flaky for a longer period, treatment aims to restore the skin’s natural protection by:

  • Reducing inflammation •Locking moisture into the skin surface
  • Reducing itch (and therefore risk of reinfection due to scratching)
  • What is Betnovate Scalp Application?
  • It contains Betamethasone Valerate 0.1%, a moderate potency (medium-strength) steroid, in an alcohol solution.
  • The steroid works by switching off some of the chemical signals causing further inflammation in the affected skin.
  • The alcohol solution transports the steroid into difficult to reach areas of the ear and kills bugs on the skin surface (this is why it may help Ear Eczema, when steroid creams may not reach the affected part).

Is Betnovate safe in children/pregnancy and breast feeding?

  • Betnovate can be used in Children over 1 year of age.
  • No studies have shown whether using topical steroids in pregnancy or breastfeeding is harmful to humans, but it is unlikely a significant amount of the medicine is passed to the baby.

Please discuss the risks and benefits of using the lotion with your doctor

How should I apply it?

The lotion needs to run through the ear and treat the whole ear canal. 

  • This is best done by lying flat on a bed (if comfortable, lie across the bed so your head can be tilted downward off the edge of the bed)
  • Lie with the affected ear pointing upward
  • Use the opposite hand to gently pull the ear up and out, which straightens the ear canal
  • Apply 2-3 drops of the lotion. The liquid will feel cool as it evaporates off the ear canal and can sting a little the first few times it is used.
  • Turn slightly toward the face-down position so the lotion can run toward the front part of the ear
  • After one minute, roll slightly onto your back, so the lotion can run toward the rear part of the ear
  • After a further minute, rise gently from the bed. Any excess lotion running out of the ear may be mopped up with cotton wool or tissue paper

How long should I use Betnovate Scalp Application for?

Betnovate Scalp Application can be used long-term for control of eczema. We recommend using it as below for the first ten weeks, after which, you can use Betnovate as infrequently as needed to keep itching in your ear under control. In some people, this may be as little as once a week. If you intend to use it long-term, ask your GP to add the medication to your repeat prescription.

First 2 weeks – Twice per day

Next 2 weeks – Once per day

Next 2 weeks – Every other day

Next 2 weeks – Twice per week

Next 2 weeks – Once per week

If the itching comes back as you reduce the dose, then go back up the scale.

You can go back up the scale as fast as you like, but only come down as shown above.

Are there any side effects?

A localised reaction or skin irritation can occur in some patients. Other side effects are very rare, these include a very small risk of causing problems with the body’s levels of the hormone Cortisol.

 

 

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