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Chondrodermatitis nodularis

What are the aims of this leaflet?

This leaflet has been written to help you understand more about chondrodermatitis nodularis.  It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is chondrodermatitis nodularis helicis?

This clumsy Latin name means that an inflammation both of the cartilage (chondro-) and of the skin (-dermatitis) causes a bump (a nodule, hence nodularis) to appear on the ear.  A simpler term - ‘painful nodule of the ear’- is slowly taking over from it.  The condition is common and harmless, but painful.

What causes chondrodermatitis nodularis?

This is not fully understood.  A nodule may form only when several things occur together.  Perhaps the most important is pressure on the skin of your ear - most commonly from sleeping mainly on one side.  Other possible contributory factors may include pressure from a telephone, damage from cold and the sun, and a poor blood supply to the ear.  Chondrodermatitis nodularis affects middle-aged or elderly people, and is more common in men than in women. It is not catching. It is not linked in any way to skin cancer.

Is it hereditary?

No.

What are the symptoms of chondrodermatitis nodularis?

The nodules hurt when pressed, and sometimes when they get cold.  The pain can be intense but is usually short-lived, though it can last for as long as an hour.  It often interferes with sleep, as people with chondrodermatitis wake up if they turn onto that side. 

What does chondrodermatitis nodularis look like?

There is usually only one nodule – most often on the outer side of the upper part of the rim of the ear.  The right ear is affected more often than the left. 

Chondrodermatitis nodularis usually comes up without any obvious cause.  Nodules grow to about a quarter of an inch across, and then stay that size.   They are round or oval, slightly raised and firmly stuck to the underlying cartilage.  They may look inflamed and their surface is scaly or crusty. A small raw area or core can often be seen centrally when the crust is removed. 

How is chondrodermatitis nodularis diagnosed?

The diagnosis is usually easy, based on the story of a tender lump on the ear - a small painful nodule on the rim of the ear is likely to be due to chondrodermatitis nodularis - but even if you think you have it, you should see your doctor as it is important to rule out a skin cancer (either of squamous or basal cell type). Just looking at the nodule can usually do this, but if there is doubt, a small piece can be removed under a local anaesthetic (a biopsy) and checked in the laboratory. 

Can chondrodermatitis nodularis be cured?

Yes - by removing the nodule.   

How can chondrodermatitis nodularis be treated?

Chondrodermatitis nodularis is harmless and not a skin cancer; but it is painful and a nuisance, and does not go away if left alone.  It is therefore worth treating.

A non-surgical treatment may be worth trying first:

·       An antibiotic cream may help if the pain is being made worse by an infection of the nodule.

·       A corticosteroid (a cortisone-like substance) can be applied as a cream, or injected into the nodule to damp down inflammation.  

·       The nodule can be frozen with liquid nitrogen.

·       Collagen can be injected under the nodule.

Surgery.  The best treatment is usually to remove the nodule surgically, having numbed the skin first with a local anaesthetic injection.  The way the nodule is removed will depend on its size, and where it lies on the ear.  Several techniques exist, but the damaged cartilage under the nodule has to be taken away too, to be sure that the problem does not come back.

What can I do?

·       Try to avoid direct and prolonged pressure on the nodule.  For example, alter the way you hold your telephone to the ear if this causes pain.  Try to sleep on the other side; make sure your pillow is soft, and consider modifying it by making a hole where the tender nodule presses into it. 

·       Avoid too much exposure to the cold and the sun.

Where can I get more information about chondrodermatitis nodularis?

Links to other Internet sites:

www.emedicine.com/derm/topic76.htm

www.dermnetnz.org/dna.cnh.html

(While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail)