By Gary M. White, MD
Chondrodermatitis nodularis helicis (CNCH) is a painful nodule on the ear of an adult representing inflammation of the cartilage after prolonged (usually night-time) pressure.
A painful, hyperkeratotic papule on the ear most often just inferior to Darwin's tubercle in an older man, is characteristic. These lesions may also occur on the antihelix. Habits which exert prolonged pressure on the ear (e.g. sleeping on that side, head phones) help trigger the condition. But it is usually sleeping on that side that does it.
If CNCH occurs in a young patient, autoimmunity and microvascular injury have been associated.
In some cases the diagnosis is obvious and a biopsy is not needed. If there is any uncertainty however, a deep shave biopsy will confirm the diagnosis, rule out squamous cell carcinoma, and may actually cure the lesion--especially those on the helix. The patient should be told to sleep on the other side or use a soft pillow or a "donut". A pillow with a hole (ear pillow) is available from various venders.
A "memory-foam" pillow has a groove running lengthwise which takes the pressure off the ear and is beneficial for most patients. Aka "Pressure Point Relief Contour Pillow".
The phone should be held against the other ear. In addition a potent topical steroid BID (e.g. class I or II) may relieve the pain and inflammation.
If these conservative measures are not sufficient, one may consider IL triamcinolone 10-40 mg/cc Qmonth, or excision of cartilage without skin.
In the first picture, note the weathering nodules at the apex.
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