Ear Eczema And Skin PH Balance

  • Reem Alamin Hassan Bachelor's degree, Biomedical Sciences, Queen Mary University of London, UK

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Have you experienced dryness and itchiness around your ears and ear canal? Have you ever been misdiagnosed with an ear infection or swimmer’s ear, but anti-fungal treatments did not give a long-term solution? 

Read on to find out how keeping your skin pH (potential of Hydrogen) in balance might be the relief you have been yearning for. 

Ear eczema is an example of atopic dermatitis, an irritation of the skin such as itchy or cracked skin. This can arise at any age due to several environmental factors or if you have a family history of eczema, hay fever, or asthma. Eczema is more common in those who are assigned female at birth (AFAB). The link between ear eczema and pH is that having an acidic nature to the skin, helps the skin cells on the uppermost layer retain their moisture and lipid content. Normal pH for skin is around 5.5 but differs slightly for those AFAB and AMAB.1 When this is disrupted, our skin barrier is compromised allowing for swelling of the skin when excess moisture is retained, resulting in a weakened barrier susceptible to infection. 

Triggers

Below are some common triggers for eczema in general:2

  • Alkaline soaps that shift the pH balance
  • Irritants i.e. Makeup, jewellery, hearing aids, earphones, chemicals from hair sprays and dyes
  • Allergens 
  • Genetic factors
  • An unbalanced diet without healthy fats and greens results in a weaker skin. A diet with Vitamin A and fats from olives, avocados and nuts.3 Overactive immune system
  • Mutation in protein Filaggrin4

Symptoms

Below are some common symptoms for eczema in general:2

  • Red, itchy, and flaky skin
  • Weeping skin with clear fluid
  • Lichenification: Thickening of skin

The importance of skin pH balance

As we have touched upon earlier, pH is the potential of hydrogen. This shows us how acidic or alkaline something is. The scale goes from 0 to 14, with 0 being acidic and 14 being alkaline. Having optimal pH prevents the growth of harmful bacteria and is known as the ‘acid mantle’. This word, first coined by 2 German physicians in 1928 refers to the invisible layer on our skin made up of sweat and sebum that helps retain the skin’s moisture and deter bacterial invasion.5

There are also more proposed mechanisms by which this mantle is formed, such as free fatty acids being released by the breakdown of fats on the surface layer of our skin and bacterial activity that causes fats to be lysed.6,7 When there is an imbalance in the skin pH such that it is higher than 5.5 making it more alkaline, it poses more risk to the barrier. Research shows that the pH of coloured skin is typically lower than white skin, which means that they are less likely to be affected by atopic dermatitis as their skin naturally has a more acidic nature.8

Source: Wikimedia Commons

Importance of pH in Ear Eczema

It should be noted that our ears are often forgotten when we talk about skincare. It is close to the scalp so gets affected by the products we use to wash and dye our hair. The chemicals may act as irritants and cause skin pH to become alkaline. Moreover, a protein called Filaggrin is also a crucial part in maintaining the acid mantle, because the protein is broken down to amino acids. Before breaking down it acts as a structural protein aiding in reinforcing the deeper layer of the skin, known as stratum corneum. 50% of people affected by eczema have a mutation in the gene coding for this protein.9

Earwax also known as Cerumen is a natural antimicrobial and lubricates the ear canal, reducing itchiness and protecting the ear from external irritants.10 Therefore it is important that we do not remove earwax with cotton buds as it not only removes the ear’s layer of protection and moisture, but can also cause severe impact resulting in pain and damage to the inner ear. The pH of ear wax is also acidic at 5.2-7.0, contributing to the low pH nature of the skin.11

Maintaining healthy skin pH in the ears

It is important to look after the skin in your ears especially if they are exposed to harsh weather conditions, allergens, and irritants from hair products. In general, it is important to use gentle shampoos and conditioners to look after the skin on your scalp and ears. When looking after the skin in your outer ear start with a gentle cleanser and follow up with a toner and pH-balanced cream to seal in moisture. It is also important to take showers with lukewarm water and avoid hot water, as this will strip away the natural oils on your skin and cause increased dryness. If you find that you are not interested in or cannot afford an extensive skincare routine, then prioritise using a pH-balanced moisturiser to help maintain healthy skin pH. 

Treatment approaches

There are no cures for eczema as there are many factors involved and your GP will prescribe you with medication that helps relieve symptoms only. You would have to follow this up with a consistent skincare routine. 

Topical Steroids

Topical corticosteroids known as topical steroids for short are usually emollient or lotion-based medication used to reduce inflammation and swelling. Your GP may prescribe you a mild steroid such as 1% hydrocortisone to help with the relief of itching. It is important to note that this is only to relieve symptoms and should not be used long-term. Prolonged use reduces the production of proteins such as filaggrin, inhibits keratinocyte (skin cell) proliferation and reduces lipid production, thus resulting in thinning of the skin, known as skin atrophy.12

Emollients and moisturisers

Find emollients that help lock in moisture and have low acidity. Olive oil acts as 2 in 1 by being an emollient and having a fairly low pH, making it suitable to be applied generously on the outer ear skin to help with flare-ups and reduce flaking. Petroleum jelly is also a good emollient as it is unscented, easy to apply and locks in moisture helping your skin to repair and recover. You can also find filaggrin-boosting moisturisers and lower pH moisturisers. Another excellent emollient is colloidal oatmeal which is finely ground oats that are rich in starches and beta-glucan which helps to lock in moisture.

They also have an anti-inflammatory nature as they contain some Phenolic avenanthramides.13 To top that off, the proteins in colloidal oatmeal act as a skin pH buffer helping restore the acid mantle. A study showed that over half of the participants had a 20% improvement by 3 days of use of colloidal oatmeal in itchiness and severity of their eczema.13,14 This emphasises the importance and effectiveness of using natural products that enhance the moisture content in our skin and do not cause irritation or thinning of the skin barrier.

Prevention of ear eczema recurrence

The first step in prevention is identifying triggers, which can range from hair products, stress, dust, and weather. As this is not always easy to identify over a short period, it is important to have a regular skincare routine to look after your ears. Start with gentle cleansers and pH-balancing moisturisers. You can also monitor the pH of your skincare products by purchasing disposable pH strips. If they are above a pH of 5.5, you would want to avoid this on your outer ear where it is affected by eczema. It is also important to keep other parts of your life in check, such as getting good sleep, eating well, cleaning hearing aids and earphones, and not removing your natural emollient and antimicrobial earwax regularly. 

Summary

I myself have suffered with dry skin on my outer ear for just over a year. I have tried corticosteroid treatments that cleared my eczema fully for a week but then returned when I stopped using them as it is not intended for long-term use. I was then advised by my GP to use a paraffin gel that gave me short-term relief and has been using petroleum jelly to avoid itching and picking at my skin. However, it has not cleared my ear eczema and my skin is still flaky and occasionally very sore if I miss applying an emollient to my ear. I realised that when I used slightly acidic olive oil it has helped with the irritation and almost cleared the eczema.

Therefore, I am going to look into trying out pH-balanced moisturisers to restore the moisture and the acidity of the skin in my ear. I have also stopped using my wireless earbuds for music and have opted for overhead earphones to reduce the physical impact they had on the skin on my outer ear. You may also benefit like myself from monitoring the triggers for your ear eczema and following the tips above to enhance your skincare to look after your ears.

References

  • Luebberding S, Krueger N, Kerscher M. Skin physiology in men and women: in vivo evaluation of 300 people including TEWL , SC hydration, sebum content and skin surface pH. Intern J of Cosmetic Sci [Internet]. 2013 [cited 2024 Feb 2]; 35(5):477–83. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ics.12068.
  • Branch NSC and O. Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases [Internet]. 2017 [cited 2024 Feb 2]. Available from: https://www.niams.nih.gov/health-topics/atopic-dermatitis.
  • Boelsma E, Van De Vijver LP, Goldbohm RA, Klöpping-Ketelaars IA, Hendriks HF, Roza L. Human skin condition and its associations with nutrient concentrations in serum and diet. The American Journal of Clinical Nutrition [Internet]. 2003 [cited 2024 Feb 2]; 77(2):348–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002916523056137.
  • Bandier J, Johansen JD, Petersen LJ, Carlsen BC. Skin pH, Atopic Dermatitis, and Filaggrin Mutations. Dermatitis [Internet]. 2014 [cited 2024 Feb 2]; 25(3):127–9. Available from: https://www.liebertpub.com/doi/10.1097/DER.0000000000000045.
  • Surber C, Humbert P, Abels C, Maibach H. The Acid Mantle: A Myth or an Essential Part of Skin Health? In: Surber C, Abels C, Maibach H, editors. Current Problems in Dermatology [Internet]. S. Karger AG; 2018 [cited 2024 Feb 2]; bk. 54, p. 1–10. Available from: https://www.karger.com/Article/FullText/489512.
  • Fluhr JW, Kao J, Ahn SK, Feingold KR, Elias PM, Jain M. Generation of Free Fatty Acids from Phospholipids Regulates Stratum Corneum Acidification and Integrity. Journal of Investigative Dermatology [Internet]. 2001 [cited 2024 Feb 2]; 117(1):44–51. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15412862.
  • Puhvel SM, Reisner RM, Amirian DA. Quantification Of Bacteria In Isolated Pilosebaceous Follicles In Normal Skin. Journal of Investigative Dermatology [Internet]. 1975 [cited 2024 Feb 2]; 65(6):525–31. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15446421.
  • Man M-Q, Lin T-K, Santiago JL, Celli A, Zhong L, Huang Z-M, et al. Basis for Enhanced Barrier Function of Pigmented Skin. Journal of Investigative Dermatology [Internet]. 2014 [cited 2024 Feb 2]; 134(9):2399–407. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15369621.
  • Osawa R, Akiyama M, Shimizu H. Filaggrin Gene Defects and the Risk of Developing Allergic Disorders. Allergology International [Internet]. 2011 [cited 2024 Feb 2]; 60(1):1–9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1323893015305013.
  • Lum CL, Jeyanthi S, Prepageran N, Vadivelu J, Raman R. Antibacterial and antifungal properties of human cerumen. J Laryngol Otol [Internet]. 2009 [cited 2024 Feb 2]; 123(4):375–8. Available from: https://www.cambridge.org/core/product/identifier/S0022215108003307/type/journal_article.
  • Oladeji SM, Babatunde OT, Babatunde LB, Sogebi OA. KNOWLEDGE OF CERUMEN AND EFFECT OF EAR SELF-CLEANING AMONG HEALTH WORKERS IN A TERTIARY HOSPITAL. J West Afr Coll Surg. 2015; 5(2):117–33.
  • Niculet E, Bobeica C, Tatu AL. Glucocorticoid-Induced Skin Atrophy: The Old and the New. CCID [Internet]. 2020 [cited 2024 Feb 2]; Volume 13:1041–50. Available from: https://www.dovepress.com/glucocorticoid-induced-skin-atrophy-the-old-and-the-new-peer-reviewed-article-CCID.
  • Lisante TA, Nunez C, Zhang P, Mathes BM. A 1% Colloidal Oatmeal Cream Alone is Effective in Reducing Symptoms of Mild to Moderate Atopic Dermatitis: Results from Two Clinical Studies. J Drugs Dermatol. 2017; 16(7):671–6.
  • https://fyra.io. Colloidal Oatmeal in the Treatment of Atopic Dermatitis. Practical Dermatology [Internet]. [cited 2024 Feb 2]. Available from: https://practicaldermatology.com/articles/2020-aug/colloidal-oatmeal-in-the-treatment-of-atopic-dermatitis.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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