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Chondrodermatitis nodularis chronica helicis or Winkler disease is a benign tender lump in the cartilaginous portion of the ear. It is most frequently located in the external part of the helix but may also be found in the anthelix or antitragus. The nodule is covered with a crust and has a tiny central core which discharges a scaly or purulent liquid. It is a characteristically extremely painful condition that prevents the sufferer from sleeping and is made worse by rubbing. Generally one-sided, it tends to affect men after the age of 40.
Histological features include transdermal elimination of a necrobiotic dermal material combined with hyalinisation of the underlying cartilage and an inflammatory reaction in the perichondrium .
Although there is still much debate about the etiology of these painful nodules, it appears likely that the very shape of the ear, which renders it vulnerable to minor trauma and rubbing, and the absence of subcutaneous tissue between the dermis and perichondrium are determining factors .
There are three ways of treating the nodules: the affected portion of cartilage can be removed, local inflammation can be reduced and the area protected against rubbing .
• Removal of the nodule: surgery involves removing or destroying the nodule and underlying cartilage. Bigger nodules are treated by cuneiform resection of the auricle; smaller nodules measuring 1 to 3 mm in diameter can be removed via a lengthways cut in the fold of the helix.
The use of CO2 laser to remove the lesion has also been proposed but its applications are limited by the ensuing cartilage exposure and risk of chondritis.
In certain specific cases, prompt use of cryotherapy has been found to prevent the pain from intensifying.
• Fight inflammation: corticosteroid injections (2.5 to 40 mg/cm3 triamcinolone acetonide) directly into the nodule twice to three times weekly have been suggested. Some cases have been cured by the twice-daily application of 0.1 percent betamethasone valerate for three to six weeks .
• Preventing rubbing: subcutaneous injection of reticulated collagen under the nodule creates a cushion between the skin and perichondrium. This relieves the pressure on the lesion and reduces pain .
In routine practice, priority is given to removing the lesion. Cryotherapy is justified in patients reporting redness and pain in the helix. If the lesion has already developed, surgery is the treatment of choice.
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