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Chondrodermatitis nodularis helicis chronicus
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Chondrodermatitis is a benign condition; the chief indication for treatment is pain causing sleep disturbance. Asymptomatic areas of chondrodermatitis do not require active intervention. The use of a pressure-relieving sponge or cushion can provide a good first-choice alternative to surgery.
Management Strategy
Chondrodermatitis usually occurs on the lateral portion of the ear on the preferred sleeping side. It is generally caused by the weight of the head on the pillow causing direct pressure and frictional irritation of the cartilage of the ear. Surgery or injury to the ear may leave irregular spicule(s) of cartilage that become a focus for sleep-related pressure. Chondrodermatitis affects the most protuberant part of the ear – most frequently the helix in men and the antihelix in women. Individuals who can only adopt one sleeping position due to arthritis or vertigo, for example, are particularly vulnerable. Requests for patients to ‘change their sleeping position’ are therefore impractical. Patients should be reassured that chondrodermatitis is not skin cancer. If there is any diagnostic uncertainty, a biopsy is warranted. Conservative treatment, such as lidocaine (lignocaine) gel, nitroglycerin gel , a potent topical corticosteroid , self-adhesive foam dressing , or a pressure-relieving cushion may be tried. If sleep is unaffected, further intervention is not necessary unless cosmesis is a concern.
Numerous surgical strategies have been described to treat chondrodermatitis. Whichever surgical technique is adopted, unless the subsequent underlying area of cartilage is smooth, without protuberant foci, the condition will inevitably recur. Although there is no ‘need’ for skin or ulcer excision, this is often undertaken as part of the chosen technique. Other destructive therapies have been advocated but tend to be less effective.
Specific Investigations
First-Line Therapies
Treatment of chondrodermatitis nodularis helicis and conventional wisdom?
Beck MH. Br J Dermatol 1985; 113: 504–5.
Topical corticosteroids (betamethasone valerate 0.1% and 3% clioquinol cream) used twice a day for up to 6 weeks resolved the condition in all patients.
This was a small case series of only five patients, with limited (eight week) follow-up only.
Intralesional triamcinolone for chondrodermatitis nodularis: a follow-up study of 60 patients
Cox NH, Denham PF. Br J Dermatol 2002; 146: 712–3.
A retrospective analysis of 60 patients with chondrodermatitis nodularis helicis (CNH) treated with 0.1 mL intralesional triamcinolone acetonide 10 mg/mL or triamcinolone hexacetonide 5 mg/mL showed good response on 43% of helix and 31% of antihelix lesions.
This author’s experience is that topical or intralesional steroids provide only temporary benefit in a minority of patients. Although their use is still advocated by clinicians, this author has stopped using this approach in favor of topical nitroglycerin or surgery.
The usefulness of 0.2% topical nitroglycerin for chondrodermatitis nodularis helicis
Sanz-Motilva V, Martorell-Calatayud A, Gutiérrez García-Rodrigo C, et al. Actas Dermosifiliogr 2015; 106: 555–61.
Ninety-three percent of 29 patients treated showed clinical improvement with a mean follow-up of 5.9 months. There were fewer side effects using the 0.2% preparation compared with the original 2% ointment.
Perichondrial arteriolar constriction inducing ischemia is implicated in the etiology of chondrodermatitis. This author has found the use of nitroglycerin ointment (0.2%) to be very effective in managing the condition non-surgically. Side effects such as headache are rare with the 0.2% preparation. Asking patients solely to not sleep on the affected side is impractical as a chronic, underlying condition often necessitates that the patient ends up on the side of the chondrodermatitis. The use of a pressure-relieving device as an adjunct to any intervention is of benefit to lessen the chances of recurrence.
Auricular pressure relieving cushions for chondrodermatitis nodularis helicis
Allen DL, Swinson PA, Arnstein PM. J Maxillofac Prosthet Tech 1998; 2: 5–10.
Thirty-five of 46 patients treated in this way had complete resolution of their symptoms.
Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach
Moncrieff M, Sassoon EM. Br J Dermatol 2004; 150: 892–4.
A simple-to-construct ear cushion design was used, made up of a bath sponge with the center removed and held in place with a head band. Thirteen out of 15 patients followed for 1 month responded.
The author (no conflicts of interest) has directed patients to use a similar pressure-relieving device, which is commercially available (CNH ear protector, Delasco.com), with good results.
Management of chondrodermatitis nodularis chronica helicis using a “doughnut pillow”
Sanu A, Koppana R, Snow DG. J Laryngol Otol 2007; 121: 1096–8.
Patients used a doughnut-shaped pillow made of orthopedic ‘memory foam’. This distributes the weight of the recumbent head more evenly and is designed to relieve the pressure on the affected ear. Thirteen of 23 (56%) patients treated remained pain free after a 1-year follow-up.
Management of chondrodermatitis nodularis helicis by auricular pressure-relieving device: a retrospective study
Belgi A, Logan RA. Br J Dermatol 2007; 157(Suppl 1): 68.
Seventy-eight patients with CNH used a custom-made ear pressure–relieving device designed and built by the local maxillofacial technicians. Of these, 48 patients responded to a questionnaire examining the outcome. Only 7 found it helpful (15%); 20 reported no benefit (42%) and 20 reported some benefit (42%).
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