Chondrodermatitis Nodularis Helicis

Chondrodermatitis nodularis helicis (CNH) is a relatively common, benign, tender inflammatory condition of the apex of the helix or on the antihelix (inner cartilage) of the ear.
Lesions typically arise on the lateral rim of the helix.
CNH is characterized by one or more spontaneously appearing tender papules.
Occurs most commonly in fair-skinned individuals who have severely sun-damaged skin.
CNH can occur in patients at any age but mostly affects middle-aged to older individuals. It more often occurs in men; 10% to 35% of cases involve women. Age at onset is similar in men and women.
Spontaneous resolution is unusual; the condition often continues unless treated.
The cause of CNH is unknown.
Neural hyperplasia and a secondary perichondritis probably account for the tenderness associated with this condition.

The onset of CNH may be precipitated by pressure, trauma, or cold. Sleeping on the affected side or holding a telephone instrument to the involved ear can be quite painful.
The nodule—actually papular in size—usually enlarges rapidly to a maximum size, approximately 4 to 8 mm, and remains stable.
Firm, often quite tender, well demarcated, and round to oval with a raised, rolled edge, and central ulcer or crust (Fig. 30.35).
Most often seen as a tender papule(s) on the apex of the helix of the ear.
Lesions on the antihelix (Fig. 30.36) are more commonly seen in women.

Differential Diagnosis (see also Chapter 31: Premalignant and Malignant Cutaneous Neoplasms)

Actinic Keratosis

Keratoacanthoma

Squamous Cell Carcinoma

Management

Intralesional injections of steroids such as triamcinolone (Kenalog; 20 to 40 mg/mL) (Fig. 30.37) may relieve discomfort and result in resolution. Several visits for these injections may be necessary.
If the patient sleeps on the affected side, changing sides or using pressure-relieving pillows or pads may be helpful.
Biopsy is indicated if the diagnosis is in doubt.
If conservative methods to relieve symptoms are unsuccessful, surgical approaches are almost always needed.
Wedge excision, curettage, electrocauterization, carbon dioxide laser ablation, and excision of the involved skin and cartilage are often curative.

Helpful Hints

Most often the patient with CNH seeks medical attention because of the pain associated with the skin lesion(s). In contrast, the cutaneous tumors listed in the differential diagnosis of CNH are usually painless and nontender.
Actinic keratoses, basal cell carcinomas, squamous cell carcinomas, and keratoacanthomas typically arise on the sun-exposed top rim of the helix, whereas CNH lesions are generally found on the lateral rim of the helix (see Fig. 30.35).