Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 18/03/2015
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Clifford M. Lawrence
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Chondrodermatitis is a benign condition; the only indication for treatment is pain causing sleep disturbance. Painless areas of chondrodermatitis can be ignored or managed conservatively. Lesions on the helix are easier to treat surgically than antihelix lesions and give better cure results. A pressure relieving cushion is a good first choice alternative to surgery for antihelix lesions.
Chondrodermatitis usually occurs on the lateral portion of the ear on the preferred sleeping side. It is generally caused by the weight of the head crushing the ear against the pillow during sleep. Ear injury or surgery may leave an irregular ear margin that becomes a focus for sleep related pressure. The most protuberant part of the ear is affected; this is generally the helix in men and the antihelix in women. Patients who can only adopt one sleeping position due to arthritis, etc., are particularly vulnerable. The incidence increases with age because ear cartilage becomes less flexible with time. Patients should be reassured that it is not skin cancer, advised to use a soft pillow that is still compressible when the head is resting on it, and to change their sleeping position. Conservative or medical treatment, such as lidocaine (lignocaine) gel, a potent topical or intralesional corticosteroid or pressure-relieving cushion can be tried in all patients. If sleep is not disturbed there is really no need for any further intervention unless cosmesis is a problem.
Numerous surgical strategies have been described to treat chondrodermatitis and most work to some degree; it is tempting to suggest that some work by making the ear so painful that the subject is forced to adapt their sleeping position until the lesion resolves spontaneously. Most authors believe that the principle of surgical treatment is excision of the affected area of cartilage without the need for skin or ulcer excision. Other destructive therapies have been advocated but overall are less effective. Antihelix lesions respond so well to cartilage excision that many recommend surgery as a first line treatment.
None required
Biopsy of a lesion only necessary if surgery is indicated. Lesions managed conservatively do not require biopsy
Beck MH. Br J Dermatol 1985; 113: 504–5.
Topical corticosteroids (betamethasone valerate cream 0.025%) used twice a day for 6 weeks and intralesional triamcinolone (0.2–0.5 mL, 10 mg/mL) are effective in almost 25% of patients.
Cox NH, Denham PF. Br J Dermatol 2002; 146: 712–13.
A retrospective analysis of 60 patients with CNH treated with 0.1 ml intralesional triamcinolone acetonide 10 mg/mL or triamcinolone hexacetonide 5 mg/mL showed good response on 43% of helix and 31% of antihelix lesions.
Flynn V, Chisholm C, Grimwood R. J Am Acad Dermatol 2011; 65: 531–6.
Topical 2% nitroglycerin ointment twice daily resulted in complete clearance and resolution of symptoms in eight of 13 CNH lesions. Four gained only symptomatic improvement, and one showed no benefit.
Reassurance that this is not a tumor puts the patient’s mind at rest. In many instances the symptoms are mild and can be tolerated without any major intervention
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Reassurance not cancer
Conservative management
Topical corticosteroids
Intralesional corticosteroids
2% topical nitroglycerin
