Cracks behind the ears in adults and children

Dry or weeping skin and cracks behind the ears are considered by dermatologists as symptoms of certain conditions or diseases that require identification for adequate treatment.

Epidemiology

According to statistics, atopic dermatitis affects 10% of children. [1]

According to some reports, seborrhea affects about 4% of the population, and dandruff (seborrheic dermatitis of the scalp) occurs in a third of all adults. [2]

Causes of the cracks behind the ears

Pointing to the possible causes of skin cracking in the retroauricular - behind the ear region, experts call:

• Irritating to skin from care products and hair dyes, perfumes, earrings and ear piercings, eyeglasses, hearing aids or headphones. In such cases, we are talking about  allergic contact dermatitis ; [3], [4]
• eczema or  atopic dermatitis , which in pediatrics is most often called  exudative diathesis ; [5]
• fungal infections (dermatophytosis), which can affect skin folds of any location; ... [6]
• seborrheic dermatitis  (known as dandruff); [7], [8]
• sebopsoriasis or  seborrheic psoriasis of the scalp ; [9]
• asteatic dermatitis (dyshidrotic or dry eczema, possible due to overdrying of the skin by frequent washing and insufficient general hydration, especially with low air humidity); [10], [11]
• spontaneous opening of the formed  atheroma behind the ear . [12], [13]

The same factors cause cracks behind the ears in a child. In addition, in children with weakened immunity (as well as in adults with severe immunosuppression), scrofula or scrofula, an atypical mycobacterial infection caused by the saprophytic non-tuberculous bacterium Micabacterium scrofulaceum,  [14]in severe cases provoking inflammation of the cervical lymph nodes (usually in children of the first five years of life).  [15]

Cracks behind the ears of a baby can be the result of diaper rash, which affects the skin folds of children at this age. Another common problem in infants with unregulated sebum production is the formation of gneiss or milk crusts on the head and behind the ears, which, in fact, is a manifestation of the same seborrheic dermatitis.

Risk factors

Among the risk factors for the appearance of cracks in the skin behind the ears are:

• lack of vitamins A, E, B2, B6, E, D3;
• low levels of zinc in the body;
• xerosis or dry skin (young children have dry skin more often than adolescents); [16]
• disruption of the sebaceous glands of the skin;
• weakened immunity;
• genetic predisposition, childhood or old age;
• a tendency to sensitize the body or a history of allergies;
• infections.

Pathogenesis

An increase in skin dryness is associated with a large amount of soap, which not only washes away the dirt, but also removes the protective sebum (sebum), without which moisture is not retained in the intercellular space of the epidermis, which leads to its cracking.

In addition, the acidic mantle on the skin's surface is destroyed - a natural barrier to bacteria and viruses. As you know, sebum is secreted by special glands and, when mixed with the secretion of sweat glands, forms an acidic microfilm (Ph of the skin from 4.5 to 6.2), which is called the mantle. At the same time, normal blood Ph is 7.4 (slightly alkaline), and such a natural combination of different acidity of the external and internal environment is a nonspecific factor in the body's defense against infections.

The pathogenesis of a chronic condition such as atopic dermatitis or eczema, which begins at an early age, is rather complex and not fully understood; probably, it is associated with a synergistic interaction of genetic factors, a violation of the barrier function of the epidermis and changes in its microbiome (bacterial colonization), as well as an increased immune response.

For example, genetics is manifested in an abnormal decrease in the level of the secondary intracellular mediator cAMP (cyclic adenosine monophosphate), which controls the activity of cells, which leads to an increased release of histamine and leukotriene, which are involved in the immune response, which are synthesized by mast cells and basophils.

Damage to the skin barrier in people with atopic dermatitis can be caused by mutations or deletions in a gene that encodes the skin protein filaggrin, which is responsible for the formation of the stratum corneum.

In response to the destruction of the skin barrier, local inflammation develops by stimulation of Th2 cytokines (type 2 T helper cells) that produce interleukins.

Also see -  Atopic and Allergic Conditions

Seborrhea is associated with a fungal infection of the scalp with Malassezia furfur and often affects the scalp along the hairline and dorsum of the auricles, which can be diagnosed as  seborrheic eczema .

Symptoms of the cracks behind the ears

As with other areas of the body, atopic dermatitis around the ears causes symptoms such as dryness and desquamation (flaking) of stratum corneum particles, redness, swelling of the subcutaneous tissue and itching, which can cause painful cracks behind the ears.

With eczema, most often redness and fissures form where the earlobe touches the skin.

When, during an  eczematous skin reaction  , weeping cracks form behind the ears, this means deeper damage to the skin with oozing of exudate (formed from the intercellular fluid of damaged tissues).

With seborrheic dermatitis of the scalp, symptoms range from slightly flaky skin (dandruff) to solid, reddened, oily, horny scaly lesions. Moreover, such areas can be not only behind the ears, but also on the face (on the cheeks, on the eyebrows and eyelids, in the nasolabial folds). Some people experience swelling and scaling inside the auricles and ear canals. [17]

Complications and consequences

In case of violation of the integrity of the skin on the auricles, the possible consequences and complications are associated with the addition of skin infections - bacterial or viral, as well as the aggravation of the course of dermatitis, which became the root cause of damage. [18], [19]

For example, in atopic dermatitis, there is a change in the skin microbiome and a decrease in resistance against lipophobic pathogens, in particular Streptococcus pyogenes and Staphylococcus aureus bacteria, which are often present on healthy skin. [20]

Penetrating into a crack in the skin, bacteria induces the production of immunoglobulins (Ig), which leads to the proliferation of T-lymphocytes and exacerbation of dermatitis.

Secondarily infected cracks behind the ears in an infant or young child can cause a long-lasting local streptoderma requiring antibiotic treatment. [21]

With seborrhea and sebopsoriasis with severe itching, leading to scratching of the skin, erythroderma may develop. [22], [23]

Diagnostics of the cracks behind the ears

The fissure behind the ear is visible to the naked eye, so a routine examination is often sufficient.

However, diagnostics in dermatology should reveal the true cause of this symptom. Therefore, blood tests may be required: general, for sugar levels, for thyroid hormones, for antibodies (Ig). And instrumental diagnostics includes  dermatoscopy .

Differential diagnosis

Differential diagnosis is carried out on the basis of the results of a more thorough and comprehensive dermatological  examination of the skin .

Treatment of the cracks behind the ears

Treatment for cracks behind the ears, in particular the choice of therapeutic agents, usually depends on the underlying cause.

Many people are helped by keeping the skin clean, dry and hydrated. Remedies for excessive dry skin and methods of their use are presented in the material -  Dry skin of the body .

After examination, the doctor prescribes medications, and these are usually external drugs. If an inflammatory focus appears with eczema behind the ears, you will need a combination of antibiotics and topical steroids, that is,  ointments that relieve inflammation , first of all, such effective agents as Levomekol and Baneocin. [24]

What means are used, read in the publications:

• Diaper rash treatment
• Treatment of atopic dermatitis
• Ointments for atopic dermatitis
• Eczema creams
• Seborrheic dermatitis ointment

To treat a complication - streptococcal inflammation - use  ointments for streptoderma .

Homeopathy can also be used using ointments such as Zincum ricini, Calendula, Graphites, Ledum palustre, Hypericum perforatum.

Vitamins of the main group and preparations of zinc and selenium can also be prescribed.

Alternative treatment is not excluded, see -  Treatment of diathesis by alternative means .

Immediately after bathing (before the skin is completely dry), you should lubricate the skin on the ears with almond or sea buckthorn oil, aloe juice, a concentrated aqueous solution of mumiyo or propolis. It is recommended to apply essential oils of tea tree, calendula, borage, jojoba, diluted with almond or refined sunflower oil to cracks (5-6 drops of essential oil per teaspoon).

Herbal treatment quickly helps children with exudative diathesis and cracks in the skin behind the ears: hygienic procedures using decoctions of chamomile flowers and calendula officinalis, herb of string or plantain leaves. 

Prevention

It is difficult to disagree with the fact that cleanliness is a guarantee of health, however, when choosing detergents for the body and hair, dermatologists advise paying attention to their composition and avoiding brightly colored gels and shampoos with a strong odor.

Special preventive measures for this case are not provided, therefore, doctors simply urge everyone to eat right (including eating less sweet and fatty foods) and adhere to a healthy lifestyle.

Forecast

After treatment, the cracks behind the ears heal, but the causes of their appearance (dry skin, dermatitis) in most cases remain. Therefore, doctors do not guarantee that this problem will not arise in the future.