Chondrodermatitis Nodularis Helicis Appearance
The most typical, primary lesion of chondrodermatitis nodularis helices, is a firm, tender, red to pink, 2- to 4-mm papule with central scale and a central keratotic punctum. The punctum has firm, adherent crust or scale, resembling a small cutaneous horn. Removal of the scale reveals a small central erosion. The surrounding skin shows scale, actinic damage with atrophy and telangiectasia.
Location on the ear
This condition is classically found on the most prominent and lateral portion of the auricle. This can occur on the helix, but also the antehelix, depending on the shape of the ear. Occasionally, there may be more than one lesion.
Differentiating from squamous cell carcinoma
Unlike a squamous cell carcinoma lesion, the sides of the CNH nodule slope down from the center, are more firm, less necrotic and more tender. Squamous cell carcinomas of the ear are typically necrotic and may bleed or ulcerate. If there is doubt about the diagnosis, a skin biopsy should be performed.
When actively inflamed, the base is red and swollen. The universal symptom is pain, described as stabbing and sharp. Any type of pressure is intolerable, and sleep may be affected if one is used to sleeping on the affected side.