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Chondrodermatitis Nodularis Helicis (CNH)

Author: Dr Vaishali Kiridaran

Chief Editor: Dr Daniel Keith

Chondrodermatitis Nodularis Helicis (CNH) is a benign but painful condition of the ear, typically affecting the helix or antihelix. While non-cancerous, it can closely mimic certain skin cancers and often causes concern due to its appearance and tenderness.

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Who Gets It?

CNH is more common in:

  • Men, particularly over age 50

  • Fair-skinned individuals with chronic sun exposure

  • People who sleep on one side, leading to prolonged pressure on the ear

  • Occasionally associated with autoimmune conditions in younger patients

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What Causes It?

The exact cause isn’t fully known, but likely contributors include:

  • Prolonged pressure on the ear (e.g. during sleep)

  • Cold exposure

  • Sun damage

  • Ischemia leading to cartilage degeneration

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Solitary ulcerated lesion on the antihelix of an elderly patient, consistent with CNH. The dark central crust and classic location raise concerns for malignancy, so a biopsy may be warranted.

Macroscopic Appearance

To the naked eye, CNH typically presents as:

  • A small (4–10 mm), firm, dome-shaped nodule

  • Located on the helix or anti-helix of the ear

  • Red or skin-coloured, sometimes with a central crust or erosion

  • Often tender or painful, especially when touched or slept on

  • May appear hyperkeratotic or scaly, and is often mistaken for a skin cancer

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Erythematous, tender nodule on the helix consistent with CNH. Classic location and appearance with no overt signs of malignancy.

Dermoscopic Appearance 

Dermoscopy can assist in distinguishing CNH from malignancies.

Key features include:

Common Dermoscopic Findings:

  • “Daisy pattern”: thick white lines radiating outward from a central yellow or brown clod. This is highly specific for CNH

  • Central keratin plug, erosion, or yellow-brown crust

  • Structureless white areas at the periphery

  • Scant or irregular vessels (unlike basal or squamous cell carcinoma)

 

Features typically absent in CNH:

  • Arborising vessels (typical of BCC)

  • White circles or prominent ulceration (common in SCC)

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In summary, the daisy pattern—radially arranged white lines converging to a central clod—is the hallmark dermoscopic clue and can significantly aid diagnosis.

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Dermoscopy shows a central yellowish keratin plug with surrounding erythema and linear white streaks on the helix.

Further dermoscopic examples:

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Additional Information

Differential Diagnosis

 

It’s important to distinguish CNH from:

 

  • Squamous cell carcinoma (SCC) – often ulcerated, bleeding, and more aggressive

  • Basal cell carcinoma (BCC) – pearly appearance with visible vessels

  • Actinic keratosis, pseudocysts, elastotic nodules, or other benign ear lesions

 

Biopsy may be necessary if there’s diagnostic uncertainty.

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Treatment Options

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Treatment focuses on relieving pressure and managing inflammation:

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  • Pressure-relieving ear cushions (“donut” pillows) is the first-line conservative approach

  • Topical nitroglycerin or corticosteroids

  • Intralesional corticosteroid injections

  • Surgical excision – for persistent or recurrent cases

  • Other options: cryotherapy, laser, photodynamic therapy, and collagen injections

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Prognosis

CNH is benign and often treatable with conservative measures. However, it can recur if pressure on the ear continues. Early recognition helps avoid unnecessary surgery and rules out malignancy.

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Key Points

• CNH is a painful nodule on the ear, often linked to pressure or trauma.
• Macroscopic clues include a tender red or skin-colored nodule with central crust.
• Dermoscopy shows a distinct “daisy pattern”, helping to rule out cancer.
• Treatments range from conservative care to surgical excision.

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