Pimples behind the ear
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Pimples behind the ear are skin lesions of an inflammatory, papular, pustular or cystic nature, located in the postauricular area – within the postauricular groove and the adjacent hairy skin. Because of the presence of numerous sebaceous glands, hair follicles and limited ventilation in this area, it is predisposed to the development of lesions of seborrheic, bacterial and mechanical etiology. Pimples behind the ear may be transient (e.g., in the course of acne or folliculitis), but can also be a sign of dermatological, infectious or systemic disorders. Proper diagnosis requires assessment of the lesion’s morphology, duration and accompanying symptoms.
Pimples behind the ear – causes
The etiology of pustules behind the ear is varied and includes both local and systemic factors. The most common causes are:
1. Folliculitis
Bacterial infection (most often Staphylococcus aureus) leads to painful, red pustules with a central purulent plug.
2. Acne vulgaris
Increased sebum production, excessive keratinization of hair follicle openings and colonization by Cutibacterium acnes can cause lesions in the postauricular area as well.
3. Epidermal cysts (sebaceous cysts)
They arise from obstruction of the sebaceous gland opening. They present as subcutaneous, well-demarcated nodules that may become secondarily infected.
4. Contact dermatitis (eczema)
An allergic or irritant reaction to hair cosmetics, dyes, cleansing agents or jewelry components.
5. Fungal infections and seborrheic dermatitis
Erythematous and scaling lesions, often accompanied by itching.
Less commonly, pustules behind the ear may be associated with:
- enlarged lymph nodes due to infection,
- autoimmune diseases,
- hidradenitis suppurativa (inverse acne).
Predisposing factors are important, such as: excessive sweating, occlusion (e.g., wearing tight masks or headphones), poor hygiene, and hormonal disturbances.
Pimples behind the ear – what do they mean
The clinical interpretation of a lesion depends on its morphology, growth dynamics and systemic symptoms.
- Painful, rapidly enlarging pustule with swelling may suggest an abscess or a furuncle.
- A firm, movable nodule under the skin without obvious inflammation often corresponds to an epidermal cyst.
- Itchy, small papules with scaling may indicate contact dermatitis or seborrheic dermatitis.
- A lesion persisting for many weeks, enlarging, or bleeding requires differential diagnosis for skin neoplasms.
In clinical practice particular attention is paid to:
- asymmetry and irregular borders of the lesion,
- ulceration or chronic oozing,
- associated enlargement of lymph nodes,
- systemic symptoms (fever, malaise).
In such situations a dermatology consultation is indicated, and if necessary dermoscopy or histopathological examination should be performed.
Pimples behind the ear – how to get rid of them
Therapeutic management depends on the causal diagnosis.
1. Topical treatment:
- antiseptic preparations (e.g., octenidine, chlorhexidine),
- antibiotic ointments in confirmed bacterial infection,
- preparations with benzoyl peroxide or retinoids for acne,
- topical glucocorticosteroids for eczema.
2. Systemic treatment (when justified):
- oral antibiotic therapy,
- antifungal treatment,
- hormonal therapy for endocrine disorders.
3. Procedural interventions:
- incision and drainage of an abscess,
- surgical removal of an epidermal cyst along with its capsule,
- laser therapy for recurrent inflammatory lesions and scars.
In clinical practice, among others, laser procedures reducing inflammatory lesions, light therapies (IPL), medical peels regulating keratinization, and surgical removal of skin lesions with histopathological examination are used.
Self-extraction of pimples is not recommended, especially for deep or painful lesions. This may lead to spread of infection, formation of an abscess, and hypertrophic scarring.
Key measures include:
- maintaining proper skin hygiene,
- avoiding occlusion and mechanical irritation,
- selecting appropriate dermocosmetics,
- control of systemic diseases (e.g., diabetes).
For recurrent, painful, or lesions persisting for more than 2–3 weeks, specialist consultation is recommended.
