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CARTILAGE DISORDERS

Chondrodermatitis nodularis

Etiology and pathogenesis

This is a common disorder of the ear, which is probably due to pressure on the cartilage. It almost always occurs on the ear that is pressed against the pillow when sleeping, and typically wakes the patient at night due to sharp pain.

Figure 30.58 Chondrodermatitis nodularis helicis at a typical site on the rim of the helix at the upper pole of the ear. These lesions are often confused with basal call carcinoma, but are usually readily differentiated by the sites affected and the symptoms.

Figure 30.59 Chondrodermatitis nodularis affecting the antihelix of the ear. This site is less common than the helix, and is affected mainly in women. The response to therapy tends to be less predictable at this site.

Clinical

The clinical lesion is often relatively insignificant compared with the symptomatic problem, and consists of a small nodule that may be crusted, keratotic, or umbilicated. The typical sites (Figs 30.58 and 30.59) are the helical rim (mainly in men, termed chondrodermatitis nodularis helicis) and the antihelix (mainly in women).

Differential diagnosis

See Table 30.3.

Treatment

In some cases, the lesions may respond to avoidance of pressure (lying on the other side, or altering the pillow). Some lesions respond to intralesional triamcinolone (about a third in a recent study), but the most reliable treatment is excision, which must include the inflamed cartilage to ensure success (and which also excludes neoplastic lesions of the ear).

Other disorders of cartilage

Most other disorders of the auricular cartilage are likely to present to otorhinolaryngologists rather than to dermatologists. Infections such as cellulitis of the ear (due to ear piercing) or malignant otitis externa (due to Pseudomonas infection in diabetic patients) may present to dermatologists, as may other acute local problems such as pseudocysts (see Fig.30.48). Congenital defects are common around the external ear and are discussed in Chapter 15; some of these are of importance due to associated renal abnormalities.

Figure 30.60 Frostbite of the ear. This is common in some occupations and communities, such as sheep farmers in mountainous areas in the north of England. Some patients develop chondrodermatitis nodularis, which can be a struggle to excise due to the rock-hard cartilage.

Figure 30.61 Radiograph of a clinically calcified, frostbitten ear, demonstrating the extensive sheet of calcified cartilage.

Figure 30.62 Weathering nodules. Small papules along the rim of the ear, which have been termed weathering nodules and related to solar damage. In the view of the present authors, these are more likely to represent cold injury if they are truly due to weathering.

    Inflammatory disorders, such as relapsing polychondritis and Wegener granulomatosis, affect cartilage and are discussed in Chapters 13 and 14. Calcification of the ear may occur in endocrine disorders such as Addison disease, but cold injury (frostbite) is a more frequent cause (Figs 30.60 and 30.61). Weathering nodules (Fig.30.62) may also be due to cold injury. A variety of nodules may occur on the ear, including epidermal tumors and nevi. The multiple nodules that may occur in gout or granuloma annulare may cause particular diagnostic confusion, and are both discussed in Chapter 11.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.