Psoriasis of the external auditory canal: a comprehensive narrative review

Psoriasis is a chronic immune-mediated inflammatory dermatosis that can involve difficult-to-treat sites in which relatively limited body surface area may still cause disproportionate symptoms and impairment in quality of life.The external auditory canal is a particularly challenging location because of its narrow anatomy, thin and sensitive skin, tendency toward scale retention with canal obstruction and conductive hearing symptoms, and frequent clinical overlap with eczematous external otitis and infectious otitis externa.Despite these challenges, psoriasis involving the external auditory canal remains under-recognized and under-studied, and clinical decision-making is often extrapolated from evidence in facial and intertriginous psoriasis and from experience managing eczematous canal disease.This narrative review synthesizes current knowledge on provoking factors and pathophysiology relevant to external auditory canal involvement, pragmatic diagnostic approaches including clinical features that warrant otolaryngology evaluation, key differential diagnoses, and evidence-informed management strategies adapted to the unique safety and delivery constraints of the canal.Available evidence suggests that external auditory canal involvement is not uncommon among patients with psoriasis and is frequently associated with pruritus and impaired quality of life.Management typically requires careful selection of low-irritancy topical formulations, short courses of appropriately potent topical corticosteroids, steroid-sparing anti-inflammatory options for maintenance, and prompt recognition and treatment of secondary infection when present.For refractory disease or when canal involvement coexists with moderate-to-severe psoriasis elsewhere, systemic and biologic therapies may be appropriate.Major evidence gaps include the absence of validated severity instruments specific to external auditory canal disease, limited controlled trials of topical agents applied to the canal, and scarce prospective data on auditory outcomes and long-term complications.