Chondrodermatitis nodularis helicis

Chondrodermatitis nodularis helicis (CDNH) is a benign, painful condition that affects the cartilaginous portion of the ear.

This chapter is set out as follows:

• It is caused by a combination of 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

• Age of presentation - most often seen in middle aged or elderly patients
• Sex - males more than females
• Symptoms - the lesion causes marked discomfort when laid on
• CDNH reaches a maximum size in a few months and then remains unchanged

Distribution

• Most are found on the upper aspect of the helix of the ear
• Lesions also occur on the antihelix; less often on other parts of the ear
• CDNH should affect pressure points, ie outward facing if caused by pressure on pillows, which most are

Morphology

• Small skin-coloured papule, the surface is frequently scaly, concealing an erosion

Dermoscopic features

• Typically reveal a characteristic 'daisy pattern' consisting of a central white-yellow or brown clod (representing keratin/crust) surrounded by radiating white lines

• The diagnosis is usually straightforward although a biopsy is occasionally needed to differentiate the lesion from a BCC or SCC

• 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
  • If patients are unable to sleep on the non-affected ear then 'pillows with a hole' can be purchased online, which have been made specifically for this condition (the hole is not always in the most appropriate position, as such patients may wish to make their own by cutting a hole in a foam pillow)
  • Patients should wear a warm hat over the ears when outside in the cold
     
• Physical treatments such as intra-lesional steroid injections, or the use of cryotherapy may benefit some patients
   
• Surgery by way of curettage or excision of the affected cartilage can be curative but recurrence rates of up to 30% have been reported