Author: Dr Anita Eshraghi, Dermatologist, Sweden. DermNet NZ Editor-in-Chief Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Original page by Dr Oakley was published in 1997. Updated August 2018.
Chondrodermatitis nodularis chronica helicis (CNH) is a common inflammatory condition which affects the skin and cartilage of the helix or antihelix of the ear.
CNH is sometimes called Winkler disease, after the dermatologist who described it in 1915. It is also called nodular chondrodermatitis and CDNH.
CNH occurs more frequently in fair-skinned and middle-aged older males, with 10–35% of the cases reported in women. It is rarely reported in children.
The exact cause of CNH is still unknown. There are several factors that contribute to its development.
CNH is a solitary, firm, and oval-shaped nodule, 4–6 mm in diameter, with central crust and surrounding erythema.
In most cases, the diagnosis is made clinically, based on the characteristic location on the helix or antihelix, and a typical history of pain and tenderness.
The differential diagnosis for CNH depends on the clinical findings. Other diagnoses to consider include:
Protective padding at night can relieve pressure on the area affected by CNH.
Nitroglycerin ointment (containing 1–2% glyceryl trinitrate) causes relaxation and vasodilation of the arteriolar smooth muscle, and can reverse the ischaemic changes seen in CNH.
Surgical options may include:
Unfortunately CNH has a 10–30% recurrence rate after surgery.
CNH usually resolves within a few months. It can recur.
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