Chondrodermatitis nodularis

• this is a chronic inflammation of the skin and cartilage occuring on the helix of the auricle
  • presentation is usually with a tender papule
    • the most protuberant part ear is affected which is generally the helix in men and the antihelix in women
  • there is generally a small papule of about 0.5cm in diameter - the lesion may have a small ulcer in the middle, often hidden by a small scale or crust. The papule may surrounded by erythema
  • multiple lesions may occur
• more common in patients who habitually sleep on one side at night - contact pressure between the head and the pillow is thought to be important in the aetiology of this condition. Hearing aids may cause chondrodermatitis as a result of pressure from one of the plastic components
• differential diagnosis includes:
  • early basal cell carcinoma but a BCC is generally painless - tend to occur on the back of the ear or in the greasier conchal skin
  • squamous cell carcinoma and solar keratoses - tend to occur on the rim of the ear or the upper part of the pinna, but not at the free edge of the cartilage
  • rarer discrete nodules on the ear include atypical fibroxanthoma (generally diagnosed as squamous cell carcinoma clinically) and melanoma (often nodular in type at this site)
    
    
• management:
  • generally requires specialist review regarding confirmation of diagnosis and treatment plan
  • treatment options for chondrodermatitis nodularis include:
    • no intervention/pressure relief
      • chondrodermatitis nodularis helicus is benign and so only those who suffer pain require treatment (1)
      • patients should be encouraged to avoid sleeping on the affected side and use foam pillows eg 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
        
        
    • topical treatment
    • options include lignocaine gel applied before retiring to bed and potent topical steroid ointments
      
      
    • steroid injections into the nodule may lead to prolonged improvement in about one third of patients (1)
      
      
    • surgery
      • excision of the papule and a sliver of the cartilage beneath and adjacent
      • but recurrence rates of up to 30% have been reported (2)

Click here for example image of this condition

Reference:

1. Dermatology in Practice 2004; 12 (2): 28-30.
2. Primary Care Dermatological Society. Chondrodermatitis nodularis helicis (Accessed 29/7/14)