Chondrodermatitis nodularis chronica helicis is a painful lesion on the ear that is also known as the painful papule of the ear (PPE).


Clinical features:

(1) The typical patient is an adult over 40 years of age with actinic skin damage.

(2) The patient has a history of chronic trauma to the ear.

(3) The lesion is a solitary, tender, erythematous papule on the ear (most often helix) that becomes crusted.

(4) The lesion may measure 3-15 mm in diameter.

(5) The lesion does not heal despite therapy.

(6) The lesion may be painful if touched,


Histologic features:

(1) A developed lesion shows an area of ulceration with granulation tissue, chronic inflammation and fibrinoid degeneration in the dermis.

(2) Pseudoepitheliomatous hyperplasia is present in the surrounding skin.

(3) A piece of degenerated cartilage can be seen at the base of the lesion if the biopsy is taken deep enough.


Differential diagnosis:

(1) basal cell carcinoma or squamous cell carcinoma

(2) chronic granuloma


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