Author: Honorary Associate Professor Amanda Oakley, Hamilton, New Zealand, 1997.
Chondrodermatitis nodularis chronica helicis (CNH) is a painful inflammatory condition affecting the ear. It is sometimes called Winkler disease.
CNH is most often seen in middle-aged or elderly men but may also affect women and younger adults. It results in a benign tender lump in the cartilaginous portion of the ear. The helix (thus helicis) is the top of the ear. Strictly speaking the condition should be called chondrodermatitis nodularis chronica antehelicis when it affects the inner rim of cartilage.
The affected area may only be a few millimetres wide, but to lie on it causes exquisite discomfort. There is often a tiny central core which may discharge a small amount of scaly material. It may persist for months or sometimes years, and may be confused with a skin cancer.
The cause of CNH appears to be pressure between the head and the pillow at night. CNH occurs in people who sleep predominantly on one side. It can be precipitated by minor trauma, such as tight headgear or a telephone headset, or by exposure to cold. Reduction in the local blood supply of the ear by a chilblain or with aging prevents adequate healing.
In most cases, the diagnosis is made clinically because of typical history of a painful lesion on the ear, and the appearance of a small tender papule that may be ulcerated. Sometimes the diagnosis is made on skin biopsy, which shows typical pathology.
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