What is Chondrodermatitis nodularis helicis?

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Chondrodermatitis nodularis helicis (CNH) is a common inflammatory condition that affects the skin and cartilage of the prominent areas of the ear known as the helix and the antihelix usually.  It can affect both men and women and does not usually occur in children.  Fair-skinned individuals who are middle aged seem to be the patient population who are most commonly afflicted with this.  It is typically unilateral (on the preferred sleeping side) but can be bilateral.

It presents as an area on the outer area of the ear (part of the rim) that is sore, tender or even painful and red.  Pain at night can prevent sleeping on the affected side.  Often there is some degree of scale or even a scab at the site.  The discomfort is what usually worries the patient and prompts them to coming in to have it evaluated. 

The exact cause is unknown but it does seem to be connected to pressure possibly being the root cause.  The theory is that repeated pressure and compromised blood to the ear inflames an area of the cartilage and thus causing the symptoms that the patient notices.  It is predominantly on the ear on the side that the person favors for sleeping and side sleepers are most vulnerable.  The pressure put upon the ear against the pillow while sleeping is thought to be causative of this condition.  Other things that put pressure on certain parts of the ear can also stimulate this to happen – like wearing of headphones, ear buds, hearing aids and use of mobile devices.  Exposure to sun and cold can trigger this as well as some connective tissue diseases like scleroderma and lupus erythematosus.  

The diagnosis is usually straightforward but sometimes a biopsy is performed to establish the correct diagnosis and rule other things like a benign irritated growth, pre-cancer (actinic keratosis), or a skin cancer (basal or squamous cell carcinoma).

CNH is a benign process that can resolve with treatment but can unfortunately recur.  Treatments include change of preferred sleeping side or change to softer item that is in contact with the ear and is the cause of the pressure, fashioning a hole in the pillow to remove all pressure from being applied to that ear, protecting the ears by wearing a hat when out in cold or windy conditions (if that is found to be the cause), topical or injected steroid (anti-inflammatory agents), or surgical removal of involved tissues.  Believe it or not there are pillows available with a pre-cut hole already in it for you and found online (thank goodness for ingenuity and Amazon!)…so know that you are not the only one with this condition.

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