Chondrodermatitis nodularis helicis (CNH) is a skin condition that affects the cartilage of the ear. It’s a painful nodule, which may or may not have a scab on it, that grows over a period of time. The nodule grows quickly, typically measuring between 2 and 4 millimeters, and then stops growing, but remains persistent.
Often the nodule appears on the ear on the side of the head that you sleep on. Chondrodermatitis nodularis helicis is sometimes referred to as Winkler’s disease. Chondrodermatitis nodularis helicis is not contagious and is most often found in men over the age of 40. However, it can also be seen in women and younger patients.
Chondrodermatitis nodularis helicis produces one defining symptom: the appearance of a raised bump (called a papule, or a nodule) on the ear. This bump is usually on the helix or antihelix of a person’s ear cartilage.
The nodule creates a sensation of pain or pressure when irritated, and it’s sensitive to the touch. Some people with CNH report episodes of stabbing pain at the area that last several hours.
The nodule often appears spontaneously. However, some patients may have preceding trauma, frostbite, or chronic sun damage prior to the appearance of this lesion. No poking or squeezing of the nodule will shrink or get rid of it, though it may bleed if you try to remove it.
People develop CNH for different reasons. Sometimes, it seems to develop for no reason at all. Some possible causes include:
- sleeping consistently on one side, which can be a source of pressure or irritation on one ear
- compromised blood supply to the cartilage
- exposure to extreme cold weather
- ear trauma due to continued use of headphones, telephones, or hearing aid devices
- prolonged sun exposure throughout life, according to some theories
The skin condition is not contagious or caused by any sort of bacteria or virus. Men over the age of 40 are the most likely to develop CNH, but women get it, too. There have also been some rare cases reported of children experiencing CNH.
However, there is little research into the actual development of CNH. There is no evidence that CNH is contagious, and no bacteria or virus is connected with the appearance of CNH.
Chondrodermatitis nodularis helicis usually presents as a raised nodule on the parts of the ear cartilage referred to as the “helix” or the “antihelix.” These are the inner and outer ridges of cartilage in the ear. If you notice that a painful nodule in your ear has appeared, you need to show it to your doctor. If you are in pain and want a referral for a specialist, tell your doctor that you are experiencing CNH symptoms and want to be examined for the condition.
A dermatologist may be able to guess what it is by looking at it. To be safe, you will probably need to get a biopsy to make sure that CNH is what’s causing the raised bump on your ear. The condition can be misdiagnosed or mistaken for skin cancer. Sometimes the skin around or on top of the nodule bleeds or becomes scaly. This makes it especially difficult to rule out malignancy without a biopsy first. Basal cell skin cancer, squamous cell skin cancer, and actinic keratosis (precancers) can all mimic a CNH.
The most common treatment for CNH used to be surgery. The surgery attempts to remove the entire nodule from the person’s ear. During the excision surgery, nerves are sometimes cut to remove the painful sensations around the papule. Even after surgery, CNH may return in the same area of the ear. This is especially true if the surgery fails to completely remove all the inflamed cartilage underneath the nodule.
The recurrence rate after this type of surgery is around 10–30 percent, according to one study.
New studies have shown that more conservative treatments for CNH may have the same overall rate of recurrence. Because of this, it may be better to avoid surgery if possible. Alternatives to surgery can include:
- sleeping with a custom pillow made for people with CNH
- applying a topical nitroglycerin treatment.
- freezing the nodule with nitrogen
- receiving laser or photodynamic therapy
Sleeping with a custom pillow or foam prosthesis is one of the recommended methods of treating the pain that comes from sleeping on the nodules. Specialty pillows that have a hole in them where the ear would otherwise be flattened against the pillowcase are sold specifically for people that have CNH. Some individuals feel that as long as they are able to sleep and not feeling pain or pressure, that’s all the treatment that they need for their CNH.
Another method of treatment is a topical nitroglycerin application. One study, which used a patch to apply the nitroglycerin to the nodule on the ear, had very successful results. This study indicated that the patch treatment, if continued over time, could improve blood flow to the area of the nodule and cause it to decrease in size.
Some dermatologists may choose to freeze the nodule with nitrogen or treat it with a series of cortisone injections. Laser treatment has also been used with some success.
Your personal medical history, your comfort level with different kinds of treatment strategies, and the treatment experience of your dermatologist are all taken into account when deciding how to treat your CNH.
Chondrodermatitis nodularis helicis can be a source of discomfort when you first become aware of it. This diagnosis can certainly be an inconvenience. However, it’s treatable by a dermatologist and doesn’t usually indicate anything more serious.
In the long term, the prognosis for dealing with CNH is good. Using conservative treatments such as custom pillows or nitroglycerin application, there’s a chance that you won’t be in any CNH pain. If concerns about the cosmetic appearance of your CNH arise, surgery is fairly straightforward and recovery is quick.