Chondrodermatitis Nodularis Helicis Workup

  • Author: Victor J Marks, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 1, 2012
 

Laboratory Studies

Magro et al. recommend that chondrodermatitis patients in the fourth decade of life should be investigated for underlying systemic disease. This recommendation originates from a study conducted by Magro et al that included 24 patients with chondrodermatitis at a mean age of 43 years who also had increased association with collagen-vascular disease, scleroderma, hypertension, thyroid disease, and heart disease.[7]

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Other Tests

Performing skin biopsy and visualizing characteristic pathologic changes with light microscopy are the standard method of diagnosis.

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Procedures

Biopsy is indicated if the diagnosis of chondrodermatitis nodularis chronica helicis (CNH) is in doubt. Often, biopsy is necessary to differentiate chondrodermatitis nodularis chronica helicis from basal cell carcinoma or squamous cell carcinoma because many patients with chondrodermatitis nodularis chronica helicis have chronic actinic damage and a history of skin cancer.

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Histologic Findings

The histologic changes are similar to those seen in decubitus ulcers, but on a smaller scale. Within the central portion of a shave biopsy, the epidermis usually is ulcerated. At the periphery, intact epidermis is edematous and acanthotic. The dermis below the ulceration demonstrates homogeneous acellular collagen degeneration with fibrin deposition. Granulation tissue flanks the zone of necrosis on both sides. A focus of cartilaginous degeneration may be present, although it is usually minimal.

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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 Micrographic Surgery and Cutaneous Oncology, American College of Physicians, American Medical Association, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Hakeem Sam, MD, PhD, FRCPC, to the development and writing of this article.

References

  1. Rex, J., Ribera, M., Bielsa, I., et al. Narrow Eliptical Excision and Cartilage Shaving for Treatment of Chondrodermatitis Nodularis. Dermatologic Surgery. 2006;32:400-404.

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

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  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. Sep 1953;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. May 2005;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. Oct 2003;49(4):720-2. [Medline].

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

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

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

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

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

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

  17. Abell E. Inflammatory diseases of the epidermal appendages and of cartilage. In: Lever WF, ed. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:416-7.

  18. Arndt KA. Chondrodermatitis helicis. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:1149-51.

  19. Lawrence CM. Chondrodermatitis nodularis. In: Arndt KA, LeBoit PE, Robinson JK, Wintroub BU, eds. Cutaneous Medicine and Surgery: An Integrated Program in Dermatology. Vol 1. Philadelphia, Pa: WB Saunders; 1996:507-11.

  20. Moschella SL, Cropley TG. Diseases of the mononuclear phagocytic system: The so-called reticuloendothelial system. In: Moschella SL, Hurley HJ, eds. Dermatology. Vol 1. Philadelphia, Pa: WB Saunders; 1992:1061-2.

 
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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.
 
 
 
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