Within the central portion of a shave biopsy the epidermis usually is ulcerated. At the periphery, intact epidermis is edematous and acanthotic. The dermis below the ulceration demonstrates homogeneous acellular collagen degeneration. Often prominent lymphocytic inflammation and a highly vascularized granulation tissue response exist. The perichondrium often is inflamed, and a focus of cartilaginous degeneration may be present, although it is usually minimal.
Medical management is often unsatisfactory.
The primary goal should be to relieve or eliminate pressure at the site of the lesion. Often this is difficult, because of the patient's preference or necessity to sleep on the side of the lesion. A special pillow is available that relieves pressure on the ear. Topical and intralesional steroids also may be effective in relieving discomfort. Collagen injections may bring relief by providing cushioning between the skin and cartilage.