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Chondrodermatitis Nodularis Helicis

  • Author: Victor J Marks, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: May 12, 2016
 

Background

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. 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.[1] Pediatric cases of chondrodermatitis nodularis chronica helicis have been reported, and one was reviewed by Grigoryants et al.[2]

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.[3]

Clinical images of chondrodermatitis nodularis chronica helicis are below.

Classic chondrodermatitis nodularis chronica helicClassic chondrodermatitis nodularis chronica helicis on the superior helix.
Close-up view of classic chondrodermatitis nodularClose-up view of classic chondrodermatitis nodularis chronica helicis.
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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.[4]

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. A 2009 report detailed chondrodermatitis nodularis chronica helicis in monozygotic twins, suggesting a possible hereditary factor.[5]

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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.[6] 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.[7]

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.

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Prognosis

The prognosis for patients with chondrodermatitis nodularis chronica helicis (CNH) is excellent, although long-term morbidity is common. Spontaneous resolution is the exception; remissions may occur, but chondrodermatitis nodularis chronica helicis usually continues unless adequately treated.

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Contributor Information and Disclosures
Author

Victor J Marks, MD Associate, Department of Dermatology, Section Chief, Dermatologic Surgery, Geisinger Health System

Victor J Marks, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American College of Physicians, American Medical Association, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kyle A Prickett, MD Resident Physician, Department of Dermatology, Geisinger Medical Center

Kyle A Prickett, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Acknowledgements

Russell Scott Akin, MD, FAAD Procedural Dermatologist, Midland Dermatology

Russell Scott Akin, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Christine A Papa, DO Instructor, Department of Dermatology, Kennedy Memorial Health System, University of Medicine and Dentistry of New Jersey

Disclosure: Nothing to disclose.

Hakeem Sam, MD, PhD, FRCPC Fellow in Procedural Dermatology (Mohs Micrographic Surgery), Division of Dermatology, Geisinger Health Center

Disclosure: Nothing to disclose.

References
  1. Rex J, Ribera M, Bielsa I, Mangas C, Xifra A, Ferrándiz C. Narrow elliptical skin excision and cartilage shaving for treatment of chondrodermatitis nodularis. Dermatol Surg. 2006 Mar. 32 (3):400-4. [Medline].

  2. Grigoryants V, Qureshi H, Patterson JW, Lin KY. Pediatric chondrodermatitis nodularis helicis. J Craniofac Surg. 2007 Jan. 18(1):228-31. [Medline].

  3. Tsai TH, Lin YC, Chen HC. Infantile chondrodermatitis nodularis. Pediatr Dermatol. 2007 May-Jun. 24(3):337-9. [Medline].

  4. Upile T, Patel NN, Jerjes W, Singh NU, Sandison A, Michaels L. Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory. Clin Otolaryngol. 2009 Apr. 34(2):147-50. [Medline].

  5. Chan HP, Neuhaus IM, Maibach HI. Chondrodermatitis nodularis chronica helicis in monozygotic twins. Clin Exp Dermatol. 2009 Apr. 34(3):358-9. [Medline].

  6. Newcomer VD, Steffen CG, Sternberg TH, Lichtenstein L. Chondrodermatitis nodularis chronica helicis; report of ninety-four cases and survey of literature, with emphasis upon pathogenesis and treatment. AMA Arch Derm Syphilol. 1953 Sep. 68(3):241-55. [Medline].

  7. Magro CM, Frambach GE, Crowson AN. Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury. J Cutan Pathol. 2005 May. 32(5):329-33. [Medline].

  8. Oelzner S, Elsner P. Bilateral chondrodermatitis nodularis chronica helicis on the free border of the helix in a woman. J Am Acad Dermatol. 2003 Oct. 49(4):720-2. [Medline].

  9. Cribier B, Scrivener Y, Peltre B. Neural hyperplasia in chondrodermatitis nodularis chronica helicis. J Am Acad Dermatol. 2006 Nov. 55(5):844-8. [Medline].

  10. Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J. Therapeutic Options of Chondrodermatitis Nodularis Helicis. Plast Surg Int. 2016. 2016:4340168. [Medline].

  11. Moncrieff M, Sassoon EM. Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach. Br J Dermatol. 2004 May. 150(5):892-4. [Medline].

  12. Travelute CR. Self-adhering foam: a simple method for pressure relief during sleep in patients with chondrodermatitis nodularis helicis. Dermatol Surg. 2013 Feb. 39(2):317-9. [Medline].

  13. Flynn V, Chisholm C, Grimwood R. Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis. J Am Acad Dermatol. 2011 Sep. 65(3):531-6. [Medline].

  14. Garrido Colmenero C, Martínez García E, Blasco Morente G, Tercedor Sánchez J. Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: a new therapeutic option. Dermatol Ther. 2014 Sep-Oct. 27(5):278-80. [Medline].

  15. Kromann N, Hoyer H, Reymann F. Chondrodermatitis nodularis chronica helicis treated with curettage and electrocauterization: follow-up of a 15-year material. Acta Derm Venereol. 1983. 63(1):85-7. [Medline].

  16. Gilaberte Y, Frias MP, Pérez-Lorenz JB. Chondrodermatitis nodularis helicis successfully treated with photodynamic therapy. Arch Dermatol. 2010 Oct. 146(10):1080-2. [Medline].

  17. Lawrence CM. The treatment of chondrodermatitis nodularis with cartilage removal alone. Arch Dermatol. 1991 Apr. 127(4):530-5. [Medline].

  18. Affleck AG. Surgical treatment of chondrodermatitis nodularis chronica helicis: conservation of normal tissue is important for optimal esthetic outcome. J Oral Maxillofac Surg. 2008 Oct. 66(10):2194. [Medline].

  19. Yaneza MM, Sheikh S. Chondrodermatitis nodularis chronica helicis excision and reconstruction. J Laryngol Otol. 2013 Jan. 127(1):63-4. [Medline].

  20. Rajan N, Langtry JA. The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis. Br J Dermatol. 2007 Oct. 157(4):744-7. [Medline].

  21. Cognetta AB Jr, Wolfe CM, Green WH, Hatfield HK. Triangular window technique: a novel approach for the surgical treatment of chondrodermatitis nodularis helicis. Dermatol Surg. 2012 Nov. 38(11):1859-62. [Medline].

  22. Affleck AG. Surgical treatment of chondrodermatitis nodularis chronica helicis: conservation of normal tissue is important for optimal esthetic outcome. J Oral Maxillofac Surg. 2008 Oct. 66(10):2194. [Medline].

  23. Ramsey ML, Marks VJ, Klingensmith MR. The chondrocutaneous helical rim advancement flap of Antia and Buch. Dermatol Surg. 1995 Nov. 21(11):970-4. [Medline].

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Classic chondrodermatitis nodularis chronica helicis on the superior helix.
Close-up view of classic chondrodermatitis nodularis chronica helicis.
Chondrodermatitis nodularis chronica helicis on the antihelix.
Taken during surgery, this photo demonstrates reflection of the skin, which reveals the underlying perichondrium and cartilage. After the cartilage is removed, the flap is reapproximated and sutured.
Taken 6 months after surgery.
Self-adhering foam in a curvilinear shape is placed on the non–hair-bearing postauricular scalp.
A rectangular piece of self-adhering foam is placed on the non–hair-bearing postauricular scalp.
 
 
 
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