Chondrodermatitis nodularis helicis is an inflammatory skin condition that affects the ear. It causes a painful bump to develop on the top rim or helix of the ear or the curved piece of cartilage just inside, known as the antihelix. The condition, abbreviated to CNH, is also known as Winkler disease.
CNH often affects those who sleep on one side of their body more than the other. The condition most commonly occurs in males aged 40 years old or older, but females and younger adults may also develop a nodule.
Below, we discuss the symptoms and causes of CNH, along with the best treatment options.
The most obvious symptom is a painful raised bump or nodule on the cartilage of the ear.
The nodule will typically grow bigger over time until it is between 5 and 10 millimeters (mm) in diameter.
There is often a tiny core in the bump that emits a scaly liquid. This liquid may cause a scab to form over the nodule when it dries.
Although small, a nodule caused by CNH is usually sensitive to touch and temperature. It can create an intensely sharp or stabbing sensation when irritated or exposed to cold.
A person cannot get rid of CNH by picking at a nodule. The lump may persist for several months or years.
When someone experiences pressure or trauma to the skin, it can be associated with CNH. People who sleep mainly on one side often develop a nodule. Experts believe changes in blood flow to the cartilage contribute to the problem.
A bump may, however, appear:
- after a trauma, such as a knock to the ear cartilage
- due to continued use of headphones or telephones
- following frostbite or recurrent sun damage
- spontaneously and for no apparent reason
Also, people with autoimmune diseases, particularly a condition known as systemic sclerosis, have reported having CNH.
Importantly, CNH is not contagious or hereditary, and it is not linked to skin cancer.
A dermatologist or doctor may be able to diagnose CNH by looking at the ear.
They will, however, probably order a biopsy to confirm this and to rule out more serious conditions. During a biopsy, a doctor will remove a small sample of the nodule, and send it away for examination under a microscope.
People sometimes mistake CNH for skin cancer, especially if the skin around the nodule bleeds or becomes scaly. This confusion is because basal cell skin cancer, squamous cell skin cancer, and precancers can resemble some CNH nodules.
People who experience CNH can treat the condition with self-care techniques and medications.
People can find relief using home remedies to improve sleep and reduce the symptoms of pain and pressure in the ear.
To relieve discomfort or pain, a person can:
- Sleep on the other side to avoid putting pressure on the nodule.
- Use a soft pillow to prevent CNH developing on the other ear.
- Make a hole in the pillow around the ear area to reduce pressure or buy a special cushion for CNH.
- Use foam rubber, held in place with a headband, to make an ear protector to wear at night. Or, wear a moleskin bandage or get a made-to-measure silicone splint.
- Avoid prolonged exposure to sun or freezing temperatures.
- Wear a warm hat, pulled over the ears, during cold and windy weather.
- Avoid pressing a phone against the ear and consider putting calls on loudspeaker when possible.
- Apply petroleum jelly to an irritated nodule.
Medication and medical treatments
If someones quality of life is affected by CNH, and they are unable to manage it with self-care techniques, a doctor can treat it with:
- Antibiotics: Antibiotic ointment may be prescribed for an ulcerated and infected CNH.
- Corticosteroids: A topical corticosteroid cream can reduce pain and redness. A doctor may alternatively administer a corticosteroid injection into the nodule.
- Collagen: This can be injected under the skin to provide a protective layer over the cartilage.
- Liquid nitrogen: To encourage the nodule to heal, a doctor may attempt to freeze it with liquid nitrogen.
- Nitroglycerin: A doctor may prescribe this treatment for severe cases of CNH. Some research reports successful use of a nitroglycerin patch to improve blood circulation to the ear. This could cause the nodule to reduce in size over time. Potential side effects include headaches, flushing, and reduced blood pressure.
- Laser treatment: Less commonly, CNH may be removed using a concentrated beam of light. This is known as laser therapy.
Surgery for CNH was once the preferred method of treatment. But recent studies suggest that more conservative treatments may be just as effective. Surgery is now reserved for severe cases or when other treatments fail to improve CNH.
When surgery is required, a doctor will usually do an excision biopsy by removing the nodule under a local anesthetic. Changes to the nerves during an operation may help to reduce pain around the CNH.
The recurrence rate of CNH after an excision biopsy is, however, estimated to be around 10 to 38 percent. It may recur because a surgeon did not succeed in removing all of the damaged cartilage during an operation.
People may experience symptoms that range from mild discomfort to severe pain when they have CNH. The condition is not, however, harmful or cancerous.
CNH is treatable, and the long-term outlook is good. Most people respond well to medications or medical procedures.
Doctors typically recommended surgery to remove the nodule when other treatments have not been successful.
Many people can manage their symptoms, at least in the short term, using home remedies, such as special pillows and changes in sleeping habits.