Chondrodermatitis Nodularis Helicis is a common solitary inflammatory condition that affects the skin and cartilage of the helix and antihelix of the ear. The lesions are small, nodular, tender, chronic inflammatory lesions that are very difficult to treat. Although most often solitary, as many as 12 nodules have been reported along the edge of the upper helix. Descriptively the lesions are 2-4 mm in diameter, well defined, slightly reddish and extremely tender. At times the surface is covered by an adherent scale or it can manifest or develop a shallow ulceration.
After the lesions have reached a certain size, growth ceases, but the lesions often persist unchanged for many years. There is no tendency to developing malignant change. Chondrodermatitis is believed to be caused by ischemic necrosis of the dermis and is believed to be associated with recurrent or direct pressure against the ear. For this reason it tends to occur on the side that the patient favors during sleep. The patient may also have a history of frostbite, chronic trauma or chronic sun exposure with numerous actinic keratosis of the face and dorsal hands.
TREATMENT: These recommendations are not designed to substitute for a clinic visit and one can not assume that every lesion on the helical rim is chondrodermatitsis…many other malignant lesions are found to involve the ear, so if you have a tender lesion of the ear please see your dermatologist. For many years the most common form of treatment is cryotherapy, similar to that used for treatment of actinic keratosis (to review this treatment for AKs click HERE). In some patients topical nitroglycerin may be effective. Patients are instructed to avoid pressure to the site and a variety of foam pillows with a hole cut to avoid pressure as well as self-adhering foam applied prior to sleep are recommended. Recalcitrant lesions may respond to shave biopsy removal or surgical excision. Patients are encouraged to change sleeping positions, but many find this difficult. To read more about Chondrodermatitis click HERE and HERE.