Chondrodermatitis nodularis chronica helicis

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]

Differentiating [disease name] from other Diseases[edit | edit source]

Chondrodermatitis nodularis chronica helicis must be differentiated from other diseases that cause a bump on the ear, such as:

Actinic Keratosis
Basal cell carcinoma
Keratoacanthoma
Squamous cell carcinoma
Gouty tophi

Epidemiology and Demographics[edit | edit source]

The disease is much common than it is reported.
CNH is seen mostly in elderly men, but may occur with women and children too.
CNH is seen mostly in fair skin individuals who are more exposed to sun, but can occur with any ethnicity.

Age[edit | edit source]

Patients of all age groups may develop [disease name].

[Disease name] is more commonly observed among patients aged [age range] years old.
[Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender[edit | edit source]

[Disease name] affects men and women equally.

[Gender 1] are more commonly affected with [disease name] than [gender 2].
The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race[edit | edit source]

There is no racial predilection for [disease name].

[Disease name] usually affects individuals of the [race 1] race.
[Race 2] individuals are less likely to develop [disease name].

Risk Factors[edit | edit source]

Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis[edit | edit source]

The majority of patients with [disease name] remain asymptomatic for [duration/years].
Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].