Chondrodermatitis nodularis helicis

    Article Contributors: 
    Neal Kumar

     

    Clinical features

    • The classic presentation of CNH is a middle-aged to elderly man with a spontaneously appearing painful nodule on the helix or antihelix.  
    • The nodule usually enlarges rapidly to its maximum size and remains stable.  
    • Onset may be precipitated by pressure, trauma, or cold.  
    • When asked, the patient sometimes admits to sleeping on the affected side.  
    • Nodules are firm, tender, well demarcated, and round to oval with a raised, rolled edge and central ulcer or crust.  
    • Removal of the crust often reveals a small channel.  
    • Color is similar to that of the surrounding skin, although a thin rim of erythema may exist.  
    • Size may range from 3-20mm.  
    • Most common location is the apex of the helix and on the right ear.

     

    Copyright : Mitsuhiro Sugiura, M.D.

     

    Histological features 

    • The histologic changes are similar to those seen in decubitus ulcers, but on a smaller scale. 
    • Within the central portion of a shave biopsy, the epidermis usually is ulcerated. 
    • At the periphery, intact epidermis is edematous and acanthotic. 
    • The dermis below the ulceration demonstrates homogeneous acellular collagen degeneration with fibrin deposition. 
    • Granulation tissue flanks the zone of necrosis on both sides. 
    • A focus of cartilaginous degeneration may be present, although it is usually minimal.

     

    For  additional information about chondrodermatitis nodularis helicis see: eMedicine  citation and PathConsult citation