The skin throughout the surface of the body is largely the same in structure and it is continuous. Therefore skin conditions can occur anywhere in the body. Some problems are more likely to affect certain areas more than others, like acne which more often occurs on the face, back and chest. While most of us are accustomed to seeing rashes on most parts of the body, a skin rash behind the ear is often considered to be unusual. But it can occur and there are certain skin conditions more likely to afflict the skin behind the ears.
The most common skin conditions to occur behind the ears are discussed below. However, just about any skin disease can affect the area. It is therefore important to consult with a dermatologist who can examine the area and make a proper diagnosis. The pictures are simply a guideline to possible skin problems behind the ears and may differ from one individual to another. Most of these conditions tend to affect the scalp primarily and then extend to the neck and the skin behind the ears.
Atopic dermatitis is a very common skin condition among children which is widely referred to as eczema. It can occur in any person of any age but more frequently occurs in infants and young children. Atopic dermatitis tends to arise in people with an allergic disposition particularly when a person or their family members have asthma and allergic rhinitis (hay fever). It is a chronic skin condition that occurs due to a combination of genetic and environmental factors.
In atopic dermatitis the skin becomes dry and itchy with acute flareups where the skin is inflamed (red and swollen). There may even be blisters and a weeping discharge. The condition tends to affect the folds of the skin – at the elbows, behind the knees and so on. The skin behind the ears is also one of the sites that may be affected. People with atopic dermatitis or a history of the skin problem are also more likely to develop contact dermatitis (discussed below).
Contact dermatitis is another inflammatory skin condition that is sometimes confused with atopic dermatitis. It can affect any person of any age. In contact dermatitis, the skin reacts to an irritant or an allergen. Irritant contact dermatitis can occur in any person when the skin becomes irritated and injured by substances (irritants). Allergic contact dermatitis occurs in people who have allergies as the immune system reacts abnormally to harmless substances (allergens).
The rash is usually limited to the area where the irritant or allergen makes contact. More common irritants or allergens include hair dyes, shampoos, other hair care products, spectacle temple tips and ear jewelry. Sometimes the irritant or allergen is not as obvious. It can also arise with occupational exposure to certain substances. The rash is typically red, swollen and itchy. In more severe cases there may be blister formation. Dryness and roughness of the skin may also occur.
Seborrheic dermatitis is a chronic inflammatory condition that occurs on the more oily areas of the skin like the scalp, face and chest. It can affect any age group. In newborns, it is known as cradle cap when it occurs on the scalp. Dandruff is another form of scalp seborrheic dermatitis that may occur in adolescents and adults. The exact cause of seborrheic dermatitis is not known but it appears to be an abnormal reaction to naturally occurring yeasts that live on the skin.
The rash may vary in presentation to some degree depending on whether it is a mild, moderate or severe case. The skin appears scaly and greasy with a yellow crust. Although this yellow crusting is considered characteristic of seborrheic dermatitis, it may sometimes not be present. On the scalp, seborrheic dermatitis may present with small white flakes of skin and this can extend to the neck and the area behind the ears. The condition is often confused with scalp psoriasis due to the thickening of the skin that may arise.
Psoriasis is another chronic inflammatory skin condition that may be the cause of a rash behind the ears. It can occur at any age and tends to affect the skin on the elbows, knees and scalp more frequently. Psoriasis appears to be an autoimmune disease although the exact cause is unknown. It tends to run in families and there are also environmental factors that play a role in its development. Sometimes it causes symptoms beyond the skin, particularly in the joint where it is known as psoriatic arthritis.
Scalp psoriasis may extend to the forehead, neck and behind the ears. The rash appears as thick red plaques which are scaly and itchy. The skin may also appear smooth and shiny. There may be episodes of acute flareups followed by periods where the symptoms clear up almost entirely (remission). Some cases of psoriasis are atypical and do not present in the characteristic manner mentioned above. It is usually symmetrical meaning that it affects both sides of the body.
A number of skin infections can involves the area behind the ear but the two most likely are tinea capitis (fungal) and impetigo (bacterial).
Tinea capitis is caused by dermatophytes, a type of fungi that has a predilection for human skin. It can occur anywhere on the body but the feet, groin and scalp are commonly affected areas. The infection is superficial as the fungi digest and feed of the outer protein layers of the skin. The skin appears dry and cracked with scaling an itchiness. Typically this appears as circular lesions, hence the term ringworm.
Impetigo is a superficial skin condition mainly caused by Staphylococci although other bacterial species may also be responsible. It tends to occur with a break in the skin like following a cut. Although the infection is superficial, impetigo is still serious and can lead to complications if not treated promptly. The skin appears red, swollen and painful with blisters or sometimes open cracks and sores.
Tinea capitis (scalp ringworm)
Impetigo (bacterial infection)
- Dermatology Atlas