Chondrodermatitis nodularis chronica helicis: Difference between revisions

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==Pathophysiology==
==Pathophysiology==


*The pathophysiology remains unclear. It may be due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
*The pathophysiology of Chondrodermatitis nodularis chronica helicis remains unclear. It may be due to an inflammatory condition from chronic pressure on ear pinna.
*Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis.
*CNH is seen mostly in elderly men. There are few cases seen in women and young, especially when CNH is associated with autoimmune or connective tissue disorders. <ref name="pmid29926164">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmid29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid28217474">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid27723195">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*CNH is seen mostly in elderly men. There are few cases seen in women and young, especially when associated with autoimmune or connective tissue disorders. <ref name="pmid29926164">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmid29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid28217474">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid27723195">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*The anatomy of ear pinna can contribute to the pathophysiology of CNH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. <ref name="pmid29210713">{{cite journal| author=Elsensohn A, Getty S, Shiu J, de Feraudy S| title=Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis. | journal=Am J Dermatopathol | year= 2018 | volume= 40 | issue= 2 | pages= 139-141 | pmid=29210713 | doi=10.1097/DAD.0000000000001027 | pmc=6075668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29210713  }}</ref>
*The anatomy of ear pinna can contribute to the pathophysiology of CNH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. <ref name="pmid29210713">{{cite journal| author=Elsensohn A, Getty S, Shiu J, de Feraudy S| title=Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis. | journal=Am J Dermatopathol | year= 2018 | volume= 40 | issue= 2 | pages= 139-141 | pmid=29210713 | doi=10.1097/DAD.0000000000001027 | pmc=6075668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29210713  }}</ref>
*In 2009, Perichondrium vasculitis theory explained above anatomical features. Because of the vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNH. <ref name="pmid282174742">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231952">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><br />
*In 2009, Perichondrium vasculitis theory explained above anatomical features. Because of the vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNH. <ref name="pmid282174742">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231952">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*On gross pathology, CNH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. <ref name="pmid277231953">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><ref name="pmid26925262">{{cite journal| author=Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J| title=Therapeutic Options of Chondrodermatitis Nodularis Helicis. | journal=Plast Surg Int | year= 2016 | volume= 2016 | issue=  | pages= 4340168 | pmid=26925262 | doi=10.1155/2016/4340168 | pmc=4748103 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26925262  }}</ref>
 
== Causes[edit | edit source] ==
 
* Chondrodermatitis nodularis chronica helicis may be caused due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
 
* Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis. <ref name="pmid299261642">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid282174743">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231954">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
 
<br />


==Diagnosis==
==Diagnosis==

Revision as of 16:42, 28 July 2021

File:Chondrodermatitis.jpg
Chondrodermatitis helicis nodularis in a 67-year-old man.


_ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Karnik Raju Paila Bangaru, M.B.B.S.[2] Kiran Singh, M.D. [3]

Synonyms and keywords:Chondrodermatitis nodularis helicis, winkler disease, ear pressure sore

Overview

Chondrodermatitis nodularis chronica helicis (also known as "Chondrodermatitis nodularis helicis"[1]:782) (CNH) is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the ear, occurring most often in men.[2]:610


Historical Perspective[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis was first discovered by Max Winkler, a dermatologist, in 1915, in a paper titled Knötchenförmige Erkrankung am Helix . [3][4]
  • in 1925, Foerster further developed the clinical, microscopic and treatment options for CNH.

Pathophysiology

  • The pathophysiology of Chondrodermatitis nodularis chronica helicis remains unclear. It may be due to an inflammatory condition from chronic pressure on ear pinna.
  • CNH is seen mostly in elderly men. There are few cases seen in women and young, especially when CNH is associated with autoimmune or connective tissue disorders. [5][6][7][8]
  • The anatomy of ear pinna can contribute to the pathophysiology of CNH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. [9]
  • In 2009, Perichondrium vasculitis theory explained above anatomical features. Because of the vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNH. [10][11]
  • On gross pathology, CNH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. [12][13]

Causes[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis may be caused due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
  • Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis. [14][15][16][17]


Diagnosis

Physical Examination

Skin

Ear

References

  1. ↑ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. ↑ Wagner G, Liefeith J, Sachse MM (2011). "Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler". J Dtsch Dermatol Ges. 9 (4): 287–91. doi:10.1111/j.1610-0387.2011.07601.x. PMID 21276202.
  4. ↑ Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R (2016). "Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm". Dermatol Surg. 42 (10): 1125–34. doi:10.1097/DSS.0000000000000817. PMID 27399947.
  5. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  6. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID 29805936.
  7. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  8. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  9. ↑ Elsensohn A, Getty S, Shiu J, de Feraudy S (2018). "Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis". Am J Dermatopathol. 40 (2): 139–141. doi:10.1097/DAD.0000000000001027. PMC 6075668. PMID 29210713.
  10. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  11. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  12. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  13. ↑ Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J (2016). "Therapeutic Options of Chondrodermatitis Nodularis Helicis". Plast Surg Int. 2016: 4340168. doi:10.1155/2016/4340168. PMC 4748103. PMID 26925262.
  14. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  15. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID https://www.ncbi.nlm.nih.gov/pubmed/29805936 Check |pmid= value (help).
  16. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  17. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 "Dermatology Atlas".


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