Chondrodermatitis Nodularis Helicis
Chondrodermatitis nodularis chronica helicis
This lesion is inflamed, red and exquisitely tender.
Features
Small (2-10mm), often inflamed, hard, exquisitely painful nodules in the upper part of the ear, usually around the apex of the greater helix. The lesions sometimes form a scale over them that, when removed, tends to recur. They are so painful that they can interfere with sleep, causing a great deal of distress. Spontaneous remission is rare.
Lesions should be biopsied before being treated conservatively, given the differential diagnosis of malignancy.
Incidence
Uncommon. Men over the age of 40 account for 90% of patients. The right ear has a higher prevalence than the left.
Aetiology
The exact aetiology is unknown. However, repeated pressure to the upper part of the ear, such as that occurring during sleep seems to be the most likely cause. Actinic damage, cold, frostbite, and repeated physical injury have also been suggested as aetiological factors.
Differential Diagnosis
Basal cell carcinoma. Actinic keratosis. Squamous cell carcinoma. Gouty tophi. Keratoacanthoma.
Treatment
Non-surgical therapy should be attempted first. This includes topical antibiotics (when the lesion is infected), topical corticosteroids, cryotherapy, laser therapy, curettage and electrocauterization, intralesional collagen injections and corticosteroid injections and simply reduction of pressure on the ear by means of a splint. Indeed, one study found that 13 of 15 patients (87%) treated with a pressure-relieving prosthesis were healed at 1 month. Recurrence is common.
Surgery is also a possibility, with simple wedge resection being useful for small lesions. Larger lesions, however, will require more complicated reconstructive techniques. That said, recurrence is lower when the lesion is treated surgically.
