Chondrodermatitis nodularis helicis is an inflammatory process of the cartilage of the ear. It is an exquisitely tender papule on the most lateral edge of the helix or antihelix. The lesion usually occurs after the age of 40 and the incidence increases with age. Men are affected more often than women. The helix is involved more commonly in men. Lesions on the antihelix are more common in women. These variations may relate in part to historical differences in sun exposure patterns, occupation, recreational activities, and hair styles.
As a rule, most patients are in the habit of sleeping on the affected side. Pressure from resting on a pillow causes pain, forcing the patient to alter sleeping position and affecting the ability to sleep comfortably. The aetiology of chondrodermatitis nodularis helicis is unclear. It is believed to be related to focal dermal necrosis due to repetitive trauma. Over many years, dermal injury may result from actinic damage, physical pressure, or a combination of both. The vascular supply to this tissue is tenuous, and damage is slow to heal. Inflammation and granulation tissue reflect attempts at healing the damaged collagen. Without treatment, the lesions persist indefinitely. Recurrences are common, even after aggressive therapy.
How does Chondrodermatitis nodularis helicis looks like?
The most typical, primary lesion of chondrodermatitis nodularis helices is a firm, tender, red to pink, 2- to 4-mm papule with central scale and a central keratotic punctum. The punctum has firm, adherent crust or scale, resembling a small cutaneous horn. Removal of the scale reveals small central erosion. The surrounding skin shows scale, actinic damage with atrophy and telangiectasia.
Location on the ear
This condition is classically found on the most prominent and lateral portion of the auricle. This can occur on the helix, but also the antehelix, depending on the shape of the ear. Occasionally, there may be more than one lesion.
Differentiating from Squamous cell carcinoma
Unlike a squamous cell carcinoma lesion, the sides of the CNH nodule slope down from the centre, are more firm, less necrotic and tenderer.Squamous cell carcinomas of the ear are typically necrotic and may bleed or ulcerate. If there is doubt about the diagnosis, a skin biopsy
should be performed.
When actively inflamed, the base is red and swollen. The universal symptom is pain, described as stabbing and sharp. Any type of pressure is intolerable, and sleep may be affected if one is used to sleeping on the affected side.
Chondrodermatitis Nodularis Helicis Treatment
Any therapy must include efforts to relieve pressure on the affected area to allow for healing. Patients who are able to sleep on the back should be encouraged to do so. Pillows should be positioned to minimize pressure on the ear. Topical therapy is rarely successful. Intralesional steroids can be effective in a minority of cases. Patients should expect some residual discomfort after injection. Surgical removal of the lesion along with the inflamed cartilage can be curative. A shave excision is directed at removing all the inflamed tissue, thus exposing the underlying cartilage. Curettage and light electrodessication of the base is performed, and the wound is allowed to heal by secondary intention. Definitive therapy involves surgical resection of the involved portion of the pinna. Recurrences can occur after any of the above therapies.