Derm Dx: Painful lesion of the ear - Clinical Advisor

Derm Dx: Painful lesion of the ear

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A 68-year-old man comes to the clinic complaining of a painful lesion affecting his right ear. The lesion has been present for several months. He is in good health, does not smoke, and has no history of skin cancer. Examination reveals a 0.5-cm crusted patch with a slightly denuded and hemorrhagic center. Cervical lymph nodes are nonpalpable. 

Chondrodermatitis nodularis helicis (CNH) is a painful condition of the helix or antihelix of the ear. The disorder is most common in middle-aged and elderly men, with fewer than 20% of cases occurring in females.1CNH presents as a tender papule...

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Chondrodermatitis nodularis helicis (CNH) is a painful condition of the helix or antihelix of the ear. The disorder is most common in middle-aged and elderly men, with fewer than 20% of cases occurring in females.1

CNH presents as a tender papule or nodule that may crust and ulcerate. Discomfort is often severe and interferes with sleep. The etiology is uncertain, although mechanical pressure and resultant vascular compression undoubtedly play a role.2 The right ear is most commonly affected.

 

Several treatment modalities are available, although relief of pressure and alleviation of repeated trauma to the site are of paramount importance. This may be accomplished by use of a protective covering over the ear when sleeping.3 Administering intralesional and topical steroid medications may hasten resolution of the condition. Most recently, topical nitroglycerin ointment applied twice daily has been demonstrated to decrease pain and enhance healing.4 Several surgical procedures have been described, including curettage and electrodessication,5 punch and grafting,6 and excision of underlying cartilage.7,8

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Rex J, Ribera M, Bielsa I, Mangas C, Xifra A, Ferrándiz C. Narrow elliptical skin excision and cartilage shaving for treatment of chondrodermatitis nodularis. Dermatol Surg. 2006;32:400-404.
  2. Upile T, Patel NN, Jerjes W, Singh NU, Sandison A, Michaels L. Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory. Clin Otolaryngol. 2009;34:147-150.
  3. Moncrieff M, Sassoon EM. Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach. Br J Dermatol. 2004;150:892-894.
  4. Flynn V, Chisholm C, Grimwood R. Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis. J Am Acad Dermatol. 2011;65:531-536.
  5. Kromann N, Høyer H, Reymann F. Chondrodermatitis nodularis chronica helicis treated with curettage and electrocauterization: follow-up of a 15-year material. Acta Derm Venereol. 1983;63:85-87.
  6. Rajan N, Langtry JA. The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis. Br J Dermatol. 2007;157:744-747.
  7. Lawrence CM. The treatment of chondrodermatitis nodularis with cartilage removal alone. Arch Dermatol. 1991;127:530-535.
  8. Yaneza MM, Sheikh S. Chondrodermatitis nodularis chronica helicis excision and reconstruction. J Laryngol Otol. 2013;127:63-64. 
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