Chondrodermatitis nodularis helicis — or CNH for short — is a condition that affects your outer ear. You’ll see inflammation and a small hard bump on the ear cartilage. It's also called Winkler's disease, named after the dermatologist who first described it in 1915.
What Are the Causes of Chondrodermatitis?
The exact cause of chondrodermatitis isn't known. Doctors believe it's caused by a combination of sun damage and pressure. Sun damage weakens and thins the skin. The thinned skin and cartilage are damaged from pressure. This causes swelling and crusting, which causes a lump. The lump is likely to experience even more pressure.
Some things that cause pressure on the ear include wearing headphones, hearing aids, or other headgear for a long period and sleeping on the same side every night. The outer rim of your ear doesn't have much tissue under the skin, and it doesn't have much blood supply. These factors make it more prone to developing sores from pressure.
What Are the Symptoms of Chondrodermatitis?
The main symptom of chondrodermatitis is a small, painful red bump or lesion on the outer rim of your ear. You may also notice:
- Soreness when you press on the bump
- Scaling and crusting of the lesion
- A raw center when the crust is removed
- Bleeding or discharge from the bump
- Pain when you lie on the affected side
Who Is at Risk of Chondrodermatitis?
Anyone can develop chondrodermatitis. However, it’s more common in the following types of people:
- Men who are middle-aged or older — who account for 70% to 90% of the cases
- People with fair skin
- People who have a long history of sun exposure
- Young women with autoimmune or connective tissue disorders
- People who have a protruding outer ear rim
What Is the Treatment for Chondrodermatitis?
There are two types of treatment for chondrodermatitis:
Surgery. Surgery for chondrodermatitis can include different kinds of excision, or cutting out the lesion or sore and rebuilding the ear rim. However, cutting out the lesion and carefully trimming away the cartilage is often effective and is the simplest type of surgery.
Conservative. Nonsurgical treatments are referred to as conservative and may include:
- Padding and bandages to relieve pressure on the sore area
- Injection of topical steroids into the lesion
- Topical steroids
- Injection of hyaluronic acid, a natural substance found in your connective tissues, which will cushion and insulate the sore spot
- Photodynamic therapy, which involves using light and medicine to remove the lesion
- Laser treatment to remove the sore
- Nitroglycerin paste, which improves blood flow to the lesion and helps it heal
- Diltiazem topical cream, which can help the area heal
- Cryosurgery, in which extreme cold is used to kill the affected tissue
- Electrocauterization, which uses electricity to produce heat to destroy the lesion
Are There Health Complications of Chondrodermatitis?
Chondrodermatitis won't go away on its own, but it doesn't usually cause other health problems. However, there are some rare complications that may show up when treating it or when leaving it untreated, such as:
- Loss of sleep and continued discomfort
- Infection due to damaged skin and exposed cartilage
- The lesion not healing with treatment
- A new inflammatory nodule coming up after treatment
Chondrodermatitis isn't skin cancer, but it often occurs in the same place that non-melanomatous skin cancer develops. Because of this, it's important to make sure that these lesions aren't skin cancer. This can be done with a biopsy — where a small sample of the tissue is removed and checked for cancer. This is especially important for men older than age 40 who’ve had severe sun exposure and for people who have bumps that don't hurt when they are pressed.
Can Chondrodermatitis Be Prevented?
To prevent chondrodermatitis from returning or progressing, you can try the following:
- Avoid direct or prolonged pressure on the affected ear.
- Avoid sleeping on the affected ear if possible.
- Use a soft pillow or cut a hole in your pillow to relieve pressure on your ear.
- Sleep with a blister-type bandage for padding.
- Avoid sun exposure
- Wear a warm hat to avoid exposing your ears to the cold