i have chondrodermatitis nodularis helicis.  i am suposed to keep all 
pressure off my ears when i lay on my side. every pillow with a hole
in it is either too soft and my ear hits the mattress or theyre so
firm they hurt
my head.  do you have any suggestions how to keep the pressure off my ears?
i have tried the Sleepeasy Cnh Pillow and its to hard.
and also do you know of anything to put on the earlobes to get them to heal?

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Request for Question Clarification by crabcakes-ga on 27 Apr 2004 08:06 PDT

Hi foamy,
 Can you tell me what you have already tried? Surgery? Ointments, creams, etc?

 What has your doctor recommended, other than the CNH pillow?

 It's important to know what you have already tried, so I don't
duplicate information you already have.

 Thank you.
 Sincerely,
 crabcakes

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Clarification of Question by foamey-ga on 27 Apr 2004 08:36 PDT

on my ears are not actual nodules they are areas on my ear lobes that
are pink and when
pressure is put on them get very red.  they are extremly sore. the dr.
said if i didnt get pressure off of them they would become open
sores and id have to have them operated on.  she just said no pressue
and to try neospoin cream and vasolene.  neither one helps.  they only
hurt when there is pressure on them--just the tinyest amount.  i hope you
can help me.

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Request for Question Clarification by crabcakes-ga on 27 Apr 2004 09:30 PDT

Thank you for your clarification, foamey. I'm in the process of
researching your question now!

Regards,
crabcakes

---

Clarification of Question by foamey-ga on 27 Apr 2004 11:11 PDT

the areas on the lobes that get very red with pressure, some
look as the skin is off.

Hi foamey,
Chondrodermatitis nodularis chronica helices, known as CNH and
sometimes Winkler?s Disease, is a benign, but common, painful
condition of the pinna (helix) of the external ear, seen more commonly
in fair-skinned men, who have been frequently exposed to the damaging
rays of the sun. The condition presents with painful papules on the
helix and antehlelix (the cartilaginous top portion of the outer ear).
CNH  is thought to be caused by cold, tissue damage, inflammation, or
pressure on the cartilage of the ear. Because of the anatomical shape
of the ear, and the fact that there is so little ?padding? from tissue
and fat in this part of the ear, the area is prone to CNH. For the
same reasons, this area of the ear is difficult to heal, leading to a
secondary condition known as perichondritis. The condition is very
difficult to treat, and I?m afraid, rarely cured. Hearing aids may
aggravate or even cause this condition.
EMedicine
http://www.emedicine.com/derm/topic76.htm
http://www.gpnotebook.co.uk/cache/1074135111.htm

 
The DermatologyCoUK site describes CNH
?Chondrodermatitis is inflammation of the cartilage and skin,
nodularis means like a lump and helices means ?on the ear? - in short,
a painful lump on the ear.?
http://www.dermatology.co.uk/sun/sundamage/article/article.asp?ArticleID=1258

Treatment Options:


?Treatment options include injection of intralesional corticosteroids
, excision along with the underlying cartilage, electrodesiccation and
curettage , and carbon dioxide laser surgery?
Scroll down to the middle of the page:
http://merck.praxis.md/index.asp?page=bpm_viewall&article_id=CPM02DE411&show_banner=no


Topical corticosteroids

Some are available over the counter, such as hyrocortisone 1%. If
these don?t help, your doctor can prescribe stronger ointments, such
as triamcinolone acetonide topical ointment.
Intralesional triamcinolone acetonide injections, given by your
doctor, can partially heal the lesions.
 http://skincareguide.com/tf/content.asp?a=613
About topical triamcinolone acetonide ointments
http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=00168000315&trx=1Z5006
http://bnf.org/bnf/bnf/current/doc/5928.htm


Topical antibiotic creams

This is a list of FDA over-the-counter (OTC) antibiotic creams/ointments:
bacitracin--Baciguent 
bacitracin zinc--Bacitracin Zinc 
chlortetracycline hydrochloride--Aureomycin 
neomycin sulfate--Neomycin, Myciguent Cream 
tetracycline hydrochloride--Achromycin
bacitracin-neomycin-polymyxin B--Lanabiotic, Medi-Quik Triple
Antibiotic, Clomycin Cream (with lidocaine anesthetic), Mycitracin
Plus Pain Reliever (with lidocaine)
bacitracin zinc-polymyxin B ointment, aerosol or powder--Polysporin,
Polysporin Powder
bacitracin zinc-neomycin-polymyxin B--Neomixin, Neosporin Original 
neomycin-polymyxin B ointment or cream--Neosporin Plus Maximum
Strength Cream (with lidocaine)

When you select an OTC ointment try one with lidocaine to help
decrease the pain, such as Mycitracin Plus Pain Reliever or Clomycin
Cream. Again, your doctor can prescribe stronger creams/ointments if
these don?t help.
The site does warn ?Whether using an OTC antibiotic or antiseptic,
consumers should realize "there are limits to what the products can
do," Lumpkins says. "People should read the label, and use the product
appropriately. If they notice a change in their condition, or if
there's redness or swelling, they shouldn't continue to try to treat
it. They should see a doctor."
http://www.fda.gov/fdac/features/496_cuts.html


Corticosteroid  or collagen injections
The doctor injects several areas with a corticosteroid  or collagen
solution to try and clear up the papule.
http://www.skinpatient.com/ptinfo/L/liquid%20nitrogen.htm

Cryotherapy
Using liquid nitrogen, a doctor can freeze the papule off the ear.
This only takes a few minutes, but may need to be done twice, on two
different visits. Resolution will be seen in 3-6 weeks. Cryotherapy is
not useful in all patients.
http://www.skinpatient.com/ptinfo/L/liquid%20nitrogen.htm
http://www.caringmedical.com/therapies/cryotherapy.asp


Surgery:

Surgical removal of nodule, is most effective, with only a 10% chance
of recurrence.

This Softcom site shows tissue samples from a CNH patient. This site
also describes how the underlying cartilage aggravates the skin
directly above, and advocates surgery as the best treatment. ?It is
quite likely that the apex of  the ridge of cartilage acts as a
pointed anvil resulting in the cutaneous changes above it. It is not
surprising that the lesion may recur if some of the underlying
cartilage is not removed.?
http://www.softcom.net/users/bweems/cnh.html


?Fifty-eight patients with chondrodermatitis nodularis on the
antihelix in 24 ears (16 women and eight men) and the helix in 40 ears
(six women and 34 men) were studied. Twelve ears responded to
intralesional steroid therapy. Under local anesthetic, 46 operations
were performed to remove cartilage without skin excision. On the
helix, a longitudinal incision was made; on the antihelix, a flap was
raised and the underlying cartilage was excised, taking care to leave
no rough cartilage edges. Follow-up (mean, 16 months; range, 4.5 to 34
months) showed that 10 of 17 antihelix lesions and 24 of 29 helix
lesions healed completely with excellent cosmetic results.
Recurrences, requiring further treatment, occurred at
cartilage-excision margins in seven ears, and further cartilage
excision alone was successful in four ears. This study demonstrates
that only cartilage needs to be removed in the surgical treatment of
chondrodermatitis nodularis.?

PMID: 2006878 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=91174512
Excision of skin lesions
http://www.dermnetnz.org/index.html
http://www.dermsmart.com/chonheli.htm

Here is a chart outlining treatment for various skin lesions:
http://www.skinsurgeryclinic.co.nz/Skin%20Lesions%20-%20v2.0%20-%2020%20sept%2001.pdf

Daily Living Assistance:

Don?t use the phone on the affected ear, or, in your case, if both
ears are affected, try using a speaker-phone only.

Avoid sleeping on the affected ear. Since both of your ears are
affected, this is a difficult task! Hopefully one of the pillows below
will help.

Dermatologists can order a custom made (custom fit for you) splint.
You?ll have to ask your doctor for this.

Wear a warm hat that covers your ears when outside in the cold or wind.

http://www.hmc.psu.edu/healthinfo/c/chondrodermatitis.htm
(Abstract only)
http://www.highbeam.com/library/doc1.asp?DOCID=1G1:18781933&num=2
http://www.dermnetnz.org/pre/dna.cnh/cnh.html


Pillows/Pads

Delasco CNH ear protector
This is a unique looking ear protector, with a band that wraps around
the head. Clicking on the blue oval Log-in button will take you to the
what is called a price list. You will be asked to register for a free
account. I did so, and the prices were still unavailable to me. Your
doctor may have access to ordering this, or, you can contact the
company directly:
Delasco   608 13th Ave. 
Council Bluffs, IA USA 51501-6401
voice: (800) 831-6273   (712) 323-3269
fax: (800) 320-9612   (712) 323-1156
 e-mail   questions@delasco.com
http://www.delasco.com/pcat/1/Patient%5FResale/CNH%5FEar%5FProtector/dlmic066/

Several pillow options here(5 pages). Page 4 has a neck pillow that
some patients use while lying in a reclining chair to sleep. Page 5
offers a water-core pillow that may help you.
http://www.promedproducts.com/Merchant2/merchant.mv?Screen=CTGY&Store_Code=PP&Category_Code=P1

Butterfly Pillow
http://www.comforthouse.com/comfort/butpil.html

This company may be able to make a pillow in the shape that would suit
you. They will send you a free sample of the ?memory? foam.
http://www.foamorder.com/memory.html
There are several shaped pillows here:
http://www.foamorder.com/pillows.html

Another water pillow.
http://www.comforthouse.com/comfort/watpil.html


Have you ever tried to sleep while sitting up? Patients with lung
problems often use these to remain upright.
http://www.comforthouse.com/comfort/bedlounge.html

Support:

Dermis net is collecting information on patients with CNH. You don?t
need to supply personal information, but you will be contributing to a
knowledge database for others.
http://www.dermis.net/info/feedback/userinput/Fragebogen_e.asp?&diagnr=380000

In case you wanted to see various forms of CNH, here are several images:
http://www.dermis.net/doia/diagnose.asp?zugr=d&lang=e&diagnr=380000&topic=t
More
http://www.dermnet.com/benignLesionsClinic/B20Chrondrodermatitis1wp/


Biopsy:

Have you had the papule biopsied to be sure it is not malignant? CNH
is not cancer, not does it lead to cancer, but the papules can
resemble a malignancy. Any nodule or papule should be examined,
microscopically to rule out a possible malignancy.
About biopsies:
http://www.skinpatient.com/ptinfo/S/skinbiopsyinfo.htm
?The most important medicolegal pitfall associated with CNH may be the
misdiagnosis of a true malignancy as CNH, thereby resulting in failure
to perform a biopsy and to treat it as a malignancy.?
http://www.emedicine.com/derm/topic76.htm


Well, foamy, I hope my answer  has provided you with some useful
information. Please keep in mind that this answer if for informational
purposes only, and not intended as a diagnosis or treatment plan. Only
your doctor can decide on the best therapy for you, however. Perhaps
one or more of the ointments/creams in my answer can calm your ear in
the meantime. Apply them regularly, following the package directions.
While it seems that a surgical procedure is your best and most lasting
option, you and your doctor will decide if that option is for you. I
wish you the best of luck in finding relief for your condition.

Sincerely,
crabcakes

Search Terms
CNH
Chondrodermatitis
Winkler syndrome
Disability pillows

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Clarification of Answer by crabcakes-ga on 27 Apr 2004 13:13 PDT

Hi again foamey,
 I forgot to add that if any part of my answer is unclear, or if I
have duplicated information you already have, please request an Answer
Clarification, before rating. As you  and I have already had several
interchanges, you can see how useful the clarification process is!

Regards,
crabcakes

i thought i got an excellent amount of information

Thank you foamey, for the stars and the tip! I hope you get those ears looked at!

By the way, one of my colleagues, nenna-ga, told me this of a friend
of hers with CNH
"He actually uses a very soft pillow that he made himelf. He got one
of those memory foam pillows, and cut out a divet in it, and then
found a soft gel insert which he laid in the bottom. It kept it cool,
and since the memory foam conformed around him, there was no
uncomfortable pressure from the divit like he had experenced before."

Perhaps this can help you too!

Sincerely,
crabcakes