Chondrodermatits Nodularis Helicis

Chondrodermatits Nodularis Helicis (CNH) 

Evaluation/Diagnostic Protocol

  1. Synonyms: 

    1. Chondrodermatitis nodularis chronic helices
    2. Chondrodermatitis nodularis chronica helices et antihelices
    3. Ear corn
  2. Key Features:

    1. Exquisitely tender nodules appear on the pinna
    2. Most patients have unilateral lesions and are over 50 years 

CNH is a tender inflammatory process of the ear.  Lesions are most common after age 40 years, with 94% of cases between 50 and 80 years. Both men and women are affected with MEN having more lesions on the helix and WOMEN, the antihelix.  Bilateral lesions are seen in 6-10% of patients.

RISK FACTORS:  cold exposure, significant sun damage, and local trauma.

PATHOGENESIS:  Precise etiology is unknown.  Predisposing factors include actinic damage, cold exposure, trauma, local ischemia, and occasionally radiotherapy.  A suggested pathogenesis is that helical lesions begin with perichondritis, extending secondarily to the skin.  On the contrary, antihelical lesions may begin with pressure-induced ischemia, involving the cartilage secondarily. 

CLINICAL FEATURES:  Nodules of CNH are skin colored to erythematous, dome shaped lesions with central crusts or keratin filled craters.  Surrounding inflammation may be noted.  The majority of lesions occur on the upper helical rim or the middle to lower antihelical rim.  These sites often correspond to the outermost portions of the pinna.  The lesions of CNH are often exquisitely tender to palpation and sleeping on side of the affected ear may be impossible.  

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