Flaky Ears and Eyebrows

Moisturizer is not working because you have more than just dry skin. Dry, flaky patches around the ears and eyebrows are a characteristic sign of seborrheic dermatitis. This is a harmless (but often stubborn) condition that is caused by the overgrowth of a type of yeast called Pityrosporum ovale. Although the yeast is normally found in small numbers on the skin of most healthy individuals, changes in body chemistry can cause it to multiply rapidly, irritating the skin and producing dry, flaky patches. Since the yeast feeds on sebum (your skin's natural oils), seborrheic dermatitis is more common in people who have oily skin and most often occurs in areas where the greatest concentration of oil glands are located: the ears, eyebrows, sides of the nose, and/or scalp. If left untreated, these areas can become red and inflamed; in severe cases, the infection may even spread to the chin and chest.

To control the yeast, I recommend using Nizoral (1 percent) Shampoo (available at drugstores) as a face wash. Squeeze a small amount into a washcloth and work up a lather in the affected areas. Rinse with lukewarm water, then apply a thin layer of over-the-counter cortisone cream (such as Cortaid or Cortizone-10). Repeat once daily until the condition disappears, then once a week to prevent recurrence. For mild cases, this routine is usually enough to control the outbreak. Continual use of cortisone can lead to thinning of the skin and stretch marks, however, so if your condition doesn't respond within two weeks, I suggest you visit a dermatologist, who may recommend prescription-strength antifungal medication.

Q2. My 7-year-old has been having pain in both ears for a couple of months. She says it feels like a crawling sensation in her ear or that it feels itchy. I've been to the doctor four times already; each time I'm told nothing is wrong. She has been on an antibiotic and allergy medicine. She has an ENT, and he also says that he can't see anything wrong with her ears. He suggested that I give her Advil or Motrin for the pain. I have been doing that — but it's an every- day thing: I feel it's too much medicine to be giving her, so I stopped. She has tubes in both ears and is diagnosed with NF1. I'm going to see another doctor about it soon but was wondering if you might be able to provide any insight.

— Lagina, California

Lagina, it is hard for me to make a diagnosis without examining your daughter, but I agree that if you are giving her Advil and Motrin every day and it is not helping, then you should stop the medication. Your daughter has a complicated medical history with neurofibromatosis type 1 and tubes in her ears. Certainly she should be followed by a pediatric neurologist for her neurofibromatosis and a pediatric ENT (ear, nose, and throat) specialist for her myringotomy tubes (the tubes in her ears). It sounds like antibiotics and allergy medications did not provide any relief from the pain/itching, so it is unlikely that a bacterial infection or allergy is the culprit.

I can suggest a couple of other possible causes of pain and/or itching that a doctor might find on exam and treat:

• Dry scaly skin or eczema can cause itching. Sometimes a lubricant can help with these symptoms. You could use a drop of mineral oil or olive oil. If that doesn't work, you might want to try an anti-inflammatory steroid like hydrocortisone, which you can find over-the-counter.
• Pain and itching can be caused by a fungal infection, though that is less common than eczema or dry skin.
• Sometimes pain and itching can result from kids picking at the skin in their ears. Make sure your daughter is not doing that!

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