Causes: It is thought to be caused by factors such as persistent pressure on the ear (e.g. secondary to sleep, headsets), trauma or cold. CNH is more common in men and with increasing age.
Clinical Presentation: The classic presentation of chondrodermatitis nodularis chronica helicis (CNH) is a middle-aged to elderly man with a spontaneously appearing painful nodule on the helix or antihelix. The nodule usually enlarges rapidly to its maximum size and remains stable. Onset may be precipitated by pressure, trauma, or cold. When asked, the patient usually admits to sleeping on the affected side.
On Examination: Nodules are firm, tender, well demarcated, and round to oval with a raised, rolled edge and central ulcer or crust. Removal of the crust often reveals a small channel. Color is similar to that of the surrounding skin, although a thin rim of erythema may be noted.
Size may range from 3-20 mm. The right ear is affected more commonly than the left, and occasionally bilateral distribution is reported. Lesions develop on the most prominent projection of the ear. The most common location is the apex of the helix. Distribution on the antihelix is more common in women.
Prognosis: The prognosis for patients with chondrodermatitis nodularis chronica helicis (CNH) is excellent, although long-term morbidity is common. Spontaneous resolution is the exception; remissions may occur, but chondrodermatitis nodularis chronica helicis usually continues unless adequately treated.
Management
- reducing pressure on the ear: foam 'ear protectors' may be used during sleep
- other treatment options include cryotherapy, steroid injection, collagen injection
- surgical treatment may be used but there is a high recurrence rate
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