SKIN 
 

January 2023     Volume 7 Issue 1 
 

(c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 647 

BRIEF ARTICLE 
 

 

Papules on the Helical Rim: Weathering Nodules 
 

Philip R. Cohen, MD1,2 
 
1Department of Dermatology, University of California, Davis Medical Center, Sacramento, CA 
2Touro University California College of Osteopathic Medicine, Vallejo, CA  
 

 
 

 
Figure 1. Weathering nodules on the helical rim of the left ear. 

 

A 64-year-old man presented with 
asymptomatic papules on both of his ears.  
He had extensive sun exposure since 
childhood and several actinic keratoses. 
However, he had no history of skin cancer.  
Examination showed smooth, 2-to-3-
millimeter, whitish papules on the helical rim 
of the left ear (two papules) (Figure 1) and 
right ear (one papule).  The papules blanched 
when the clinician applied pressure to the 
adjacent helix.  Hence, the suspected 
diagnosis of weathering nodules was 

confirmed. The patient’s clinical information 
has been included in a prior publication.1 

 
Weathering nodules are small, skin-colored 
to white papules that can appear on the 
helices of typically older patients with a 
history of extensive sun exposure. When 
pressure is applied to the adjacent helical 
rim, weathering nodules blanch. This is 
referred to as a positive blanch sign.1,2 
 



SKIN 
 

January 2023     Volume 7 Issue 1 
 

(c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 648 

The differential diagnosis of weathering 
nodules includes several other conditions:  
actinic keratosis, amyloidosis, basal cell 
carcinoma, calcinosis cutis, 
chondrodermatitis nodularis helicis, 
cutaneous B-cell lymphoma, cutaneous 
metastasis, elastotic nodule, gout, 
keratoacanthoma, rheumatoid nodule, 
sarcoidosis, squamous cell carcinoma, 
trichilemmomas, and verruca vulgaris.  Many 
of these conditions cannot be definitively 
established based on clinical appearance.  
Therefore, a biopsy may be necessary to 
establish the diagnosis.1-4 
 

In conclusion, the differential diagnosis of 
helical rim papules is diverse. Many of the 
conditions can have a similar appearance.  
Although a biopsy is frequently necessary to 
establish the diagnosis, weathering nodules 
may be differentiated from other causes of 
papules on the helical rim when a positive 
blanch sign is observed. 
 
Conflict of Interest Disclosures: None 
 
Funding: None 
 
Corresponding Author: 
Philip R. Cohen, MD 
10991 Twinleaf Court 
San Diego, CA 92131 
Email: mitehead@gmail.com 

 
 
References: 
1.  Udkoff J, Cohen PR. A report of 10 

individuals with weathering nodules and 
review of the literature. Indian J Dermatol.  
2016;61(4):433-436. 

2.  Udkoff J, Cohen PR. Using the blanch sign to 
differentiate weathering nodules from 
auricular tophaceous gout.  Cutis.  
2016;98(6):392. 

3.  Chabra I, Singh R.  Gouty tophi on the ear:  a 
review.  Cutis.  2013;92(4):190-192. 

4.  Salah H, Urso B, Khachemoune A. Review of 
the etiopathogenesis and management 
options of chondrodermatitis nodularis 
chronica helicis. Cureus. 2018;10(3):e2367. 

  

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