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  and PathConsult

Cases associated with this book:

Painful lesion on the ear
Author: Neal Kumar

Conference: Tufts First Year Medical Student's Dermatopathology Elective

Firm nodule on the pinna
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Conference: Tufts First Year Medical Student's Dermatopathology Elective

Common, benign, painful condition of the helix of the ear
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Conference: Tufts First Year Medical Student's Dermatopathology Elective

Spontaneously appearing and rapidly growing nodule on the helix
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Conference: Tufts First Year Medical Student's Dermatopathology Elective

Negative biopsy to rule out Chondrodermatitis nodularis helicis
Author: Neal Kumar

Conference: Tufts First Year Medical Student's Dermatopathology Elective

Early chondrodermatitis nodularis helicis?
Author: