Chondermatitis nodularis helicis

Latest update 16/06/09

This chapter is set out as follows:

• Aetiology
• Key diagnostic features
• Management

Aetiology

• Chondrodermatitis nodularis helicis (CDNH) is a painful condition that affects the cartilaginous portion of the ear
• It is caused by pressure and a compromised local blood supply – in some patients this arises as a result of habitually sleeping on one side at night. Cold weather can also be a trigger

Key diagnostic features

• Age of presentation – most often seen in middle aged or elderly patients
• Symptoms – the lesion causes marked discomfort when laid on. CDNH reaches a maximum size in a few months and then remains unchanged
• Sex – males more than females
• Distribution – most are found at the upper pole of the helix. Lesions also occur on the antihelix and less often on other parts of the ear
• Appearance - small skin coloured nodule, the surface is frequently scaly, concealing a small ulcer
• The diagnosis is usually straightforward although a biopsy is occasionally needed to differentiate the lesion from a BCC or SCC

Management

• Provide a patient information leaflet
• Conservative measures should be the first line of treatment. Patients should be encouraged to avoid sleeping on the affected side and use foam pillows (e.g. a Dunlopillow). Alternatively patients can cut a hole out of foam, rubber or a bath sponge to fit around the ear at night and hold in place with an elastic headband. Patients should wear a warm hat over the ears when outside in the cold
• Physical treatments such as intra-lesional injection of cortisone, or the use of cryotherapy may benefit some patients
• Surgery by way of curettage of the affected cartilage or excision can be curative but recurrence rates of up to 30% have been reported

	Figure 1 - CDNH of anti-helix Note the central scale
	Figure 2 - CDNH upper pole of helix
	Figure 3 - CDNH upper pole of helix
	Figure 4 - CDNH upper pole of helix