Wat is Chondrodermatitis Nodularis Helicis?

Medication and medical treatments

If someones quality of life is affected by CNH, and they are unable to manage it with self-care techniques, a doctor can treat it with:

• Antibiotics: Antibiotic ointment may be prescribed for an ulcerated and infected CNH.
• Corticosteroids: A topical corticosteroid cream can reduce pain and redness. A doctor may alternatively administer a corticosteroid injection into the nodule.
• Collagen: This can be injected under the skin to provide a protective layer over the cartilage.
• Liquid nitrogen: To encourage the nodule to heal, a doctor may attempt to freeze it with liquid nitrogen.
• Nitroglycerin: A doctor may prescribe this treatment for severe cases of CNH. Some research reports successful use of a nitroglycerin patch to improve blood circulation to the ear. This could cause the nodule to reduce in size over time. Potential side effects include headaches , flushing, and reduced blood pressure.
• Laser treatment: Less commonly, CNH may be removed using a concentrated beam of light. This is known as laser therapy.

Chondrodermatitis Nodularis Helicis

Chondrodermatitis nodularis chronica helicis (CNH) is a common, benign, painful condition of the helix or antihelix of the ear. Chondrodermatitis nodularis chronica helicis more often affects middle-aged or older men, but cases are also reported in women. [1, 2, 3] In a 2006 report by Rex et al, of 74 patients treated for chondrodermatitis, 72.9% of patients were men while 16.2% were women. [4] The etiology of CNH is unknown and likely multifactorial. Most authorities believe it is caused by prolonged and excessive pressure.The thinning skin and cartilage seen with aging may be a contributing factor. [5]

Pediatric cases of chondrodermatitis nodularis chronica helicis have been reported, and one was reviewed by Grigoryants et al. [6] An additional case has been reported in a 9-month-old infant. History associated with this case indicated the infant slept on the ear of occurrence, where she developed 2 nodules. The infant recently had started sleeping on a hard pillow, which contributed to the lesion. An excisional biopsy of this lesion at 9 months showed histologic features consistent with chondrodermatitis nodularis. The papule resolved with a change in sleeping position over 6 months. [7]

Clinical images of chondrodermatitis nodularis chronica helicis are below.

--> Classic chondrodermatitis nodularis chronica helicis on the superior helix.

Treatment is initially conservative and includes pressure avoidance or pressure relief by sleeping on the opposite side, padding of the ear with sponges or foam, and use of a donut pillow. [5] Topical antibiotics may relieve pain caused by secondary infections. Topical and intralesional steroids also may be effective in relieving discomfort. Collagen injections may bring relief by providing cushioning between the skin and cartilage. Other interventions include topical nitroglycerin gel, cryotherapy, and photodynamic therapy. Wedge resection should be considered when the lesion recurs despite multiple attempts of less invasive interventions. If specific efforts to relieve pressure are unsuccessful, surgical approaches almost always are needed. [8]

Epidemiology

Frequency

The exact incidence of chondrodermatitis nodularis chronica helicis is unknown. Newcomer et al found chondrodermatitis nodularis chronica helicis to be the most common condition of the external ear seen in their clinic. [13] The incidence in patients age 60-80 years is predominantly male, while cases presenting in young females appear to be associated with evidence of underlying systemic illness in some instances. [14]

Race

Chondrodermatitis nodularis chronica helicis occurs most commonly in fair-skinned individuals with severely sun-damaged skin, however, it can occur in persons of any races.

Sex

Although chondrodermatitis nodularis chronica helicis mostly occurs in men, 10-35% of cases involve women.

Age

Chondrodermatitis nodularis chronica helicis can occur in patients of any age but mostly affects middle-aged to older individuals. Age at onset is similar in men and women.

Pathophysiology

The exact cause of chondrodermatitis nodularis chronica helicis is unknown, although most authorities believe it is caused by prolonged and excessive pressure. Several anatomic features of the ear predispose persons to the development of this condition. The ear has relatively little subcutaneous tissue for insulation and padding, and only small dermal blood vessels supply the epidermis, dermis, perichondrium, and cartilage. Dermal inflammation, edema, and necrosis from trauma, cold, actinic damage, or pressure probably initiate the disease. In most cases, focal pressure on the stiff cartilage most likely produces damage to the cartilage and overlying skin. Anatomic features of the ear, as listed above, prevent adequate healing and lead to secondary perichondritis. The right ear is more commonly involved. A 2009 report concluded that specific perichondrial arteriolar changes may be the cause of chondrodermatitis nodularis chronica helicis. [9]

Although most authors in the past have regarded chondrodermatitis nodularis chronica helicis as an idiopathic disorder with no systemic associations, exceptions to this have been noted. Chondrodermatitis nodularis chronica helicis may occasionally be associated with autoimmune or connective-tissue disorders, including autoimmune thyroiditis, lupus erythematosus, dermatomyositis, and scleroderma. Such cases may be more common in pediatric or young adult female patients.

In a case series of 215 patients with CNH, 15.34% were also diagnosed with chronic inflammatory and autoimmune diseases (CADs). The most frequent CADs reported were polymyalgia rheumatica (3%), psoriasis/psoriatic arthritis (2%), rheumatoid arthritis (1%), CREST syndrome, vitiligo, and chronic dermatitis (< 1%). [10]

A 2009 report detailed chondrodermatitis nodularis chronica helicis in monozygotic twins, suggesting a possible hereditary factor. [11]