A hot spot on the cheek or neck below an ear

What this tends to look like

• Sore patch on the cheek, jawline, or the side of the neck under one ear
• Almost always on one side only, and the same side each time it happens
• Dog shakes their head, tilts it slightly, or scratches at that ear with a hind foot
• Sometimes a smell, dark waxy discharge, or redness inside the ear flap
• Fur worn away in a scratch line running from the ear down toward the patch
• May flinch or pull away when you touch the base of that ear

What is usually going on

A hot spot below one ear is not usually a skin problem that happens to be near an ear. It is a scratching injury, and the ear is why the dog is scratching. Dogs scratch an itchy ear with a hind claw in a downward sweep, and the claw breaks the skin on the cheek or neck. Treat the patch and leave the ear, and the dog carries on scratching and the patch comes straight back.

This matters because ear disease is easy to underestimate from the outside. A canal can be inflamed and painful with an ear flap that looks perfectly normal, and you cannot see down a dog's ear canal without a scope. It also matters because you should not put anything into an ear without knowing whether the eardrum is intact, which is another thing you cannot check at home. Some ear preparations are genuinely harmful behind a ruptured drum.

So the plan here has two halves that run at the same time. The vet deals with the ear, which is the cause. You deal with the patch as you would any fresh hot spot, and you stop the scratching in the meantime, because the claw is what keeps reopening it.

What people commonly use

Educational information only — not veterinary advice. Check with your vet before starting anything new.

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What you can do at home

• Get that ear examined down the canal. This is the actual treatment and it is not something you can do at home
• Do not put drops, oil, water or cleaner into the ear until a vet has looked. If the drum is not intact, some of it does real harm
• Stop the scratching in the meantime. A cone stops the hind foot reaching the head, which is the point
• Keep the sore patch clean and dry with cool water and a proper pat dry, and leave it open to air
• Trim the fur back around the patch if you safely can, and keep the ear flap lifted to let air in
• Note which side and whether this has happened before on the same side, which is useful information

What progress should look like

How long to give this before you conclude it is not working.

• Within a few daysGet the ear seen. The patch will not settle reliably while the ear is still itching.
• Two to four days after ear treatment startsHead shaking and scratching should drop noticeably. That is your signal the cause is being handled.
• Five to ten daysThe skin patch should be dry and closing, on the same course as any other hot spot.
• Two to three weeksEar recheck. Ear infections that look better on day five and are stopped early are the ones that come back.

When to stop and call your vet

• Head tilt, loss of balance, circling, or flicking eye movements, which needs same-day attention
• Pain severe enough that the dog will not let you near the head at all
• Discharge or smell from the ear, or a swollen, thickened ear flap
• Any hot spot spreading toward an eye or eyelid