Tenderness is the hallmark of chondrodermatitis nodularis chronica helicis (CNCH). Patients pull away when the lesion is touched, and they are often awakened at night when they roll over and the pillow comes into contact with the area. Some lesions are subject to sudden episodes of intense pain not associated with contact of any kind. CNCH is a chronic disease of the skin of the ear, which presents as one or several small, dome-shaped, skin-colored, or erythematous papular excrescences, usually at the apex of the helix or anthelix (Fig. 54-1). An adherent scale overlying a central horny plug is evident in the typical lesion. The right ear is more often involved than the left. CNCH is largely a disease of the middle-aged and elderly. Men are more commonly affected than women. The cause is thought to be localized trauma from excessive telephone use, earphones, head bands, and the like, although clear-cut evidence for such is seldom present.