Benign · AuricularPressure-relatedICD-10 H61.0
Chondrodermatitis nodularis helicis
CNH · chondrodermatitis nodularis chronica helicis · Winkler disease · chondrodermatitis nodularis antihelicis
Chondrodermatitis nodularis helicis is a benign, painful inflammatory condition of the skin and cartilage of the helix or antihelix. The classic lesion is a small, exquisitely tender, crusted nodule on the ear, often on the sleeping side. In skin-oncology practice the important point is not to over-treat typical CNH, but to biopsy or excise lesions that are enlarging, indurated, ulcerated, bleeding, non-tender, atypical or clinically uncertain because SCC, keratoacanthoma, BCC and actinic keratosis can look similar on the sun-exposed ear.
CurrentLast reviewed 5 June 2026
Pathogenesis and risk factors
- Local pressure, impaired blood supply and trauma to auricular cartilage are the main practical drivers.
- Often occurs on the side the patient sleeps on; hearing aids, headphones, mobile-phone pressure, helmets and cold exposure can contribute.
- Sun damage is common on the helix and antihelix, which is one reason malignant mimics must stay in the differential.
- Classically affects middle-aged and older adults, especially fair-skinned men, but it can occur in women and rarely in children.
- Connective-tissue disease has been reported as an association; consider it if the presentation is multifocal, bilateral or accompanied by relevant systemic features.
Clinical features
- Solitary, firm, oval or dome-shaped nodule, typically 4-6 mm, with central crust or scale and surrounding erythema.
- Most common on the helix in men and antihelix in women, though either site can be involved.
- Marked tenderness is the key clinical clue; pain at night may prevent sleeping on the affected side.
- Can bleed or discharge scant keratinous/scaly material, especially if ulcerated or traumatised.
- Bilateral lesions are possible but should prompt careful reconsideration of pressure, devices and differentials.
Diagnosis and when to biopsy
- Clinical diagnosis is reasonable for a classic painful helix/antihelix lesion with a typical pressure history.
- Biopsy or excise if diagnosis is uncertain, pain is absent, the lesion is enlarging, indurated, bleeding, unusually ulcerated, fixed, pigmented, recurrent after treatment, or in a high-risk skin-cancer patient.
- Important differentials: cutaneous SCC, keratoacanthoma, BCC, actinic keratosis, viral wart, gouty tophus and calcinosis cutis.
- If sampled, ensure the base and any suspicious edge are included; superficial shave alone may miss invasive SCC at an auricular site.
Management
- Pressure offloading is first-line: avoid sleeping on the affected side, use a soft pillow, foam ear protector, doughnut pillow or pillow with a pressure-relief hole.
- Protect from cold and wind; use simple wound care such as petroleum jelly and a light dressing if ulcerated.
- Intralesional corticosteroid can reduce inflammation in selected cases.
- Topical glyceryl trinitrate/nitroglycerin has been used to improve local perfusion; counsel about headache, irritation and nitrate contraindications.
- Persistent, recurrent or diagnostically uncertain lesions may be treated by excision with cartilage shaving, punch excision with grafting, or curettage/secondary-intention healing.
Outcome
- CNH can resolve with sustained pressure relief, although improvement may take months.
- Recurrence is common if the pressure driver persists.
- Published surgical recurrence is often quoted around 10-30%; recurrence should prompt review of both offloading and the original diagnosis.
- There is no intrinsic malignant transformation risk, but the auricular site has a high background burden of actinic keratosis, BCC and SCC.
References
- DermNet. Chondrodermatitis nodularis helicis. Updated August 2018.
- Sanu A, Koppana R, Snow DG. Management of chondrodermatitis nodularis chronica helicis using a doughnut pillow. J Laryngol Otol. 2007;121:1096-1098.
- Kuen-Spiegl M et al. Chondrodermatitis nodularis chronica helicis: a conservative therapeutic approach by decompression. J Dtsch Dermatol Ges. 2011;9:292-296.
- Rex J et al. Narrow elliptical skin excision and cartilage shaving for treatment of chondrodermatitis nodularis. Dermatol Surg. 2006;32:400-404.
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