Derm Dx: Tender Lesion on the Ear - Clinical Advisor

Derm Dx: Tender Lesion on the Ear

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A 70-year-old man presents for evaluation of a lesion on his left ear that is slightly tender. He first noted it approximately 2 months ago. He denies localized bleeding or other symptoms. He has no history of skin cancer. Examination reveals a 0.4-cm papule with a central crust. Scattered actinic keratoses and lentigos are noted on his face.

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Chondrodermatitis nodularis helicis (CNH) is a painful papule that arises on the external surface of the ear. The condition was first reported in 1915 by the German dermatologist Max Winkler, who documented it in 8 men.1   The disorder is most...

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Chondrodermatitis nodularis helicis (CNH) is a painful papule that arises on the external surface of the ear. The condition was first reported in 1915 by the German dermatologist Max Winkler, who documented it in 8 men.1   The disorder is most common in men aged ≥50 years; <20% of cases occur in women.2 The lesion of CNH is characteristically tender, which may interfere with sleep. Over time the papule may crust and ulcerate. The cause of CNH is uncertain, although mechanical pressure is thought to induce localized vascular compression, which leads to ischemic damage of underlying cartilage.3  

CNH may resolve if pressure and repeated trauma are alleviated, although most cases require medical or surgical intervention. Intralesional steroids and topical nitroglycerin ointment may promote resolution.4,5 Surgical excision is readily accomplished; however, depending on technique, a small percentage of cases recur.1

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as associate professor of medicine at Commonwealth Medical College and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Salah H, Urso BA, Khachemoune A. Review of the etiopathogenesis and management options of chondrodermatitis nodularis chronica helicis. Cureus. 2018;10(3):e2367.

2. 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(3):400-404.  

3. 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(2):147-150.

4. Cox NH, Denham PF. Intralesional triamcinolone for chondrodermatitis nodularis: a follow-up study of 60 patients. Br J Dermatol. 2002;146(4):712-713.

5. Flynn V, Chisholm C, Grimwood R. Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis. J Am Acad Dermatol. 2011;65(3):531-536.

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