Winkler's disease
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  • this is a chronic inflammation of the skin and cartilage occuring on the helix of the auricle
    • presentation is usually with a tender papule
      • the most protuberant part ear is affected which is generally the helix in men and the antihelix in women
    • there is generally a small papule of about 0.5cm in diameter - the lesion may have a small ulcer in the middle, often hidden by a small scale or crust. The papule may surrounded by erythema
    • multiple lesions may occur
  • more common in patients who habitually sleep on one side at night - contact pressure between the head and the pillow is thought to be important in the aetiology of this condition. Hearing aids may cause chondrodermatitis as a result of pressure from one of the plastic components
  • differential diagnosis includes:
    • early basal cell carcinoma but a BCC is generally painless - tend to occur on the back of the ear or in the greasier conchal skin
    • squamous cell carcinoma and solar keratoses - tend to occur on the rim of the ear or the upper part of the pinna, but not at the free edge of the cartilage
    • rarer discrete nodules on the ear include atypical fibroxanthoma (generally diagnosed as squamous cell carcinoma clinically) and melanoma (often nodular in type at this site)

  • management:
    • generally requires specialist review regarding confirmation of diagnosis and treatment plan
    • treatment options for chondrodermatitis nodularis include:
      • no intervention/pressure relief
        • chondrodermatitis nodularis helicus is benign and so only those who suffer pain require treatment (1)
        • patients should be encouraged to avoid sleeping on the affected side and use foam pillows eg a Dunlopillow
        • alternatively patients can cut a hole out of foam, rubber or a bath sponge to fit around the ear at night and hold in place with an elastic headband
        • patients should wear a warm hat over the ears when outside in the cold

      • topical treatment
        • options include lignocaine gel applied before retiring to bed and potent topical steroid ointments

      • steroid injections into the nodule may lead to prolonged improvement in about one third of patients (1)

      • surgery
        • excision of the papule and a sliver of the cartilage beneath and adjacent
        • but recurrence rates of up to 30% have been reported (2)

Click here for example image of this condition

Reference:

  1. Dermatology in Practice 2004; 12 (2): 28-30.
  2. Primary Care Dermatological Society. Chondrodermatitis nodularis helicis (Accessed 29/7/14)

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