Relapsing Papules on the Antihelix of the Left Ear

Abstract

A man in his 20s presented with a 10-year history of relapsing papules on the antihelix of the left ear. Less frequently, the papules were found on the right ear as well. Sometimes the lesions were painful to applied pressure or when exposed to cold winds.On physical examination, the right external ear showed no abnormalities, and the left antihelix showed 5 yellowish papules with surrounding erythema and scattered telangiectasias, firm in consistency and tender to applied pressure. Each lesion measured 3 to 5 mm in size (Figure, A). There was no history of trauma, infection, insect bites, tuberculosis, or diabetes mellitus. The patient used methylphenidate hydrochloride to treat attention-deficit/ hyperactivity disorder.The lesions were excised to establish a diagnosis. Excision of the lesions was performed under local anesthetic. Both the dermis and underlying cartilage were excised.Histologic examination showed an intact epidermis, without ulceration. Also the cartilage and perichondrium were not histologically abnormal. In the dermis, lesions were found with central degeneration (necrobiosis) of collagen, surrounded by palisading histiocytes. A few lymphocytes were present as well (Figure, B and C). Mucin stains showed the presence of mucin in the necrobiotic foci (arrow) (Figure, D). Periodic acid-Schiff and auraminerhodamine stains remained negative for mycobacteria.What is your diagnosis?

Unilateral, painless auricular papules

“…In terms of associations, some case reports noted a history of repeated occupational trauma, and in one case there was a history of cosmetic piercing to the ear. 2,3,5 However, most, like our patient, did not exhibit any links. 3,5 The clinical differential diagnosis of auricular GA includes chondrodermatitis nodularis helicis, intercartilaginous pseudocyst and scarring (hypertrophic and keloid).…”

“…2,3,5 However, most, like our patient, did not exhibit any links. 3,5 The clinical differential diagnosis of auricular GA includes chondrodermatitis nodularis helicis, intercartilaginous pseudocyst and scarring (hypertrophic and keloid). 1 Perforating dermatoses, including perforating collagenosis and sarcoidosis, should also be considered, 6 although there was no histological evidence of perforation in our patient.…”

“…1 GA localized to the auricular areas is uncommon, with only a few documented reports, mainly isolated case reports, in the literature. [2][3][4][5] The most commonly reported presentation is of painless, bilateral, skincoloured, asymptomatic papules predominantly located on the antihelix and less often on the helical rim and ear lobe. [2][3][4][5] Although GA generally affects females more than males, all cases of localized auricular GA reported in the literature have affected males exclusively, with an age range of 7-40 years.…”

“…Various treatments, including surgical excision, cryotherapy, topical and intralesional corticosteroids and topical calcineurin inhibitors have been tried, with varying success. [2][3][4][5] Advice on avoidance of trauma was given to two patients who suffered repeated occupational trauma, and in both cases, improvement was noted. 3 One case had recurrence of lesions after surgical excision.…”

“…Advice on avoidance of trauma was given to two patients who suffered repeated occupational trauma, and in both cases, improvement was noted 3 . One case had recurrence of lesions after surgical excision 5 . Overall, the prognosis for GA is good, and many cases resolve spontaneously within a few years, thus treatment is indicated only for patients who have symptomatic lesions or cosmetic concerns.…”