Why Do I Get Pimples In My Ear?

A pimple arises due to the accumulation of dead skin cells, oil, and debris in the pores. The accumulation of dead skin cells results in a  blockage, which leads to an increase in oil production giving way to bacterial growth, hence resulting in inflammation and pain.¹

A pimple can arise anywhere on the skin including the interior of an ear. Pimples are often caused by an increase in oil production and are mostly found on areas of skin that have the most (oil) sebaceous glands.² However, due to lack of fat in the ear, ear pimples happen to be discomforting, irritating and painful. 

Pimples result from acne, a skin condition that occurs when hair follicles become clogged with oil and dead skin cells.^{5, 6} Acne causes spots, oily skin and sometimes skin that's hot or painful to touch. These spots may present as whiteheads, blackheads or pimples.⁵

Overview

There are oil glands (sebaceous glands) found all over the body. They produce an oil called sebum, which keeps the skin moist. The glands drain into hair follicles. If sebum is overproduced, it can cause dead skin cells to stick together. Acne occurs when these dead cells and oil build up and clog the pores of the hair follicles. These may become inflamed if infected by bacteria and may appear painful, swollen or as skin discolouration around the pimple.⁶ Acne can occur in all ages, though it is more common in adolescents. Symptoms of acne include pimples, blackheads and whiteheads. In a whitehead, the clogged pores bulge outwards under the affected skin, while in a blackhead, an opening exists, linking the clogged pores to the external surface.⁵ Pimples may be found in the face, eyelid, lip, ear, back, armpits or buttocks.  An ear pimple can appear in different shapes and sizes. They may appear small and insignificant but can progress to become a painful boil.⁸ Ear pimples are also known as sebaceous cysts or ear zits.¹¹ 

Pimples are not contagious or cancerous; however, they may affect the quality of life, including causing emotional stress resulting from anxiety, low self-esteem or depression in persons who may become self-conscious of their appearance. Blood hormone changes, pre-menstruation, excessive heat and humidity, sweating, and use of makeup and cosmetic products have been shown to aggravate acne.³   Other risk factors include certain skin care products, such as moisturizing creams or oils that might block skin pores, medications containing corticosteroids, testosterone or lithium and certain foods such as bread, bagels and chips.⁶ 

Chronic stress also aggravates acne by increasing the secretion of adrenal androgens, which results in sebaceous hyperplasia.7 Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing flesh-coloured or yellowish, shiny, often umbilicated bumps on the face. Pimples are self-limiting, but if they persist, there are effective treatments available. These medications can be bought over the counter or on prescription by a medical professional as they have side effects which may range from mild, such as dry or itching skin, to more severe, such as suicide. Effective home remedies include washing the face with warm water and gentle soap, removing makeup at the end of the day, and staying hydrated.

Causes of pimples in the ear

The outer part of the ear consists of the auricle and outer ear canal. The ear canal contains sebaceous glands that produce oil and ear wax (cerumen). These secretions help to clean the ears of any dirt or germs and are naturally drained by the body.⁹ The glands also help to keep the hair moist and healthy. The human skin also has diverse and rich microbial flora that contribute to the maintenance of our anatomy and physiology. These florae are bacterial organisms and exist harmlessly; however, can cause diseases when one is compromised.¹² 

In adolescents, usually, at pubertal age, hormonal changes trigger excess sebum production, which then modifies the activity of one group of this harmless bacteria known as P. acne living on our skin. These modified bacteria lead to activities that are antagonistic to the human body, such as inflammation of the clogged pores, thus contributing to the formation of pimples.⁵ Hormones also clog pores by thickening the hair follicles and blocking drainage. Outer ear infections are caused by bacteria and typically lead to redness and swelling in the ear. ⁴ 

Another common cause is otitis external, which is the inflammation of the ear canal. Otitis externa is also known as a swimmer’s ear because the ear canal is more vulnerable to inflammation if repeatedly exposed to water.^4,10 Formation of ear pimples can be stimulated by inflamed hair follicles, use of oily gels, increased sebum (oil) production, allergies to cosmetic products, and trauma from frequently inserting earbuds or piercings.² Acne has been linked to family history, so one has a higher chance of developing it if both parents had it; however, there is no evidence yet linking it to sexual activity or diet.⁵ 

Management and treatment for pimples in the ear

Pimples are self-limiting, which means they will heal on their own if left alone. Avoid using your hands or any instruments to extract the pimple, as this can cause further trauma to the ear or even lead to an infection, especially as the ear canal leads directly to the inner ear. If symptoms persist or worsen, it is advised to seek professional advice and treatment. 

Since pimples are a form of acne, acne treatment is used to relieve the symptoms. The choice of treatment depends on how severe the symptoms are.⁵ One can use over-the-counter creams and medications. Painkillers and disinfectant ear drops or sprays are the medications that are commonly used to treat outer ear infections. These are available as over-the-counter medications from pharmacies. 

However, if these fail to work, one needs to consult the doctor for prescription treatment.¹ The treatment options include 

• Antibiotic creams that control the growth of acne-causing bacteria. The recommended course for antibiotics is 6–8 weeks in order to avoid antibiotic resistance and further bacterial infection⁵ 
• A 2.5%–5% concentration of Benzoyl peroxide prevents the growth of acne-causing bacteria and is commonly used for the treatment of acne. They should be used sparingly and on medical advice as they can irritate the skin and make it more sensitive to sunlight, among other side effects.⁵ They can also be found in many products, including creams, serums, and face washes¹ 
• Retinoid cream can also be used to treat pimples. It is applied on the skin 20 minutes after washing it and loosens the bonds between skin cells and dissolves dead skin cells.¹ However, one should protect the skin after using it. The use of retinoids and similar products can cause severe side effects and are risky during pregnancy.⁵  Therefore, this should only be used following a prescription by a doctor
• Nonsteroidal anti-inflammatory drugs such as azelaic acid work by reducing inflammation, thus reducing pain and sensitivity. The side effects are milder, so they are used if retinoids or benzoyl peroxide do not work.⁵
• Salicylic acid can also be used as an anti-acne ingredient that is highly effective, owing to its anti-inflammatory, keratolytic, and antibacterial properties. It works by dissolving the dead skin cells and exfoliating the skin, thus preventing clogging of pores. However, it needs to be used in low concentrations directly on the pimple.¹
• Corticosteroid injections are also used for the treatment of a keloid or hypertrophic scar. Steroids are injected directly into the scar tissue to decrease itching, redness and burning sensations that these scars may produce.¹
• In women, hormonal therapies like the combined contraceptive oral pill can be beneficial if symptoms appear with conditions associated with hormone imbalance, such as monthly periods or polycystic ovarian syndrome.⁵ However, it may take up to a year before symptoms are completely resolved. Some other contraceptives, like the progestogen-only pill and implants, can worsen symptoms
• Comedone extraction - If the pimple is extremely painful, a dermatologist may suggest extraction. This is done by using a sterile comedones extractor to remove the comedones or acne content.¹
• Ear drops prescribed by a doctor are also used to treat acute outer ear infections caused by bacteria⁴

How can I prevent pimples in the ear?

• To prevent pimples in the ear, one should avoid what causes ear pimples to form by washing regularly to remove dead skin cells and excess oil, cleaning foreign objects regularly, like earbuds, before inserting them, and not sharing foreign objects with other people. 
• To prevent outer ear infections, which normally lead to pimples, swelling, and redness, one should wear a snug-fitting swimming cap that helps to keep water from entering the ear while swimming, showering or having a bath⁴
• One should also prevent earwax buildup and, thus, should have their ear cleaned before engaging in a lot of swimming. 
• One should also avoid using earplugs to protect ears from noise, dust or water too often if they have sensitive ears⁴

FAQs

Are pimples in the ear common?

It is common to have ear pimples since pimples are a common skin problem that can form on any part of the body, including the ear.¹

Is it safe to pop pimples in the ear?

Due to the lack of fat in the ear, ear pimples happen to be more discomforting; hence, the urge to pop the pimples will be high.¹  However, popping pimples is not recommended because there are some conditions that might have similar symptoms to ear pimples, such as keloids, basal cell carcinoma, sebaceous cysts, etc, which need to be diagnosed by a medical professional. Moreover, squeezing pimples and rubbing the skin have been known to increase acne lesions and may lead to scars.³

When should I see a doctor for my pimples in the ear?

One should see a doctor if the pimples are persistent, multiple dots form around the ear and if there is pus discharge on the pimple. One should visit a dermatologist when pimples do not respond to over-the-counter medication and home remedies.

Summary

Pimples result from acne, a skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It causes spots, oily skin and sometimes skin that's hot or painful to touch. To prevent pimples in the ear, one should wash regularly to remove dead skin cells and excess oil, clean foreign objects e.g. earbuds regularly before inserting them, and not share foreign objects with other people. Since pimples are a form of acne, acne treatment is used to relieve the symptoms. One can use over-the-counter creams and medications. However, if these fail to work, one needs to consult the doctor for prescription treatment.