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. [10]
Other Tests
Performing skin biopsy and visualizing characteristic pathologic changes with light microscopy are the standard method of diagnosis.
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.
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. Changes of proliferative fasciitis may rarely be noted. [13]
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Classic chondrodermatitis nodularis chronica helicis on the superior helix.
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Close-up view of classic chondrodermatitis nodularis chronica helicis.
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Chondrodermatitis nodularis chronica helicis on the antihelix.
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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.
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Taken 6 months after surgery.
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Self-adhering foam in a curvilinear shape is placed on the non–hair-bearing postauricular scalp.
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A rectangular piece of self-adhering foam is placed on the non–hair-bearing postauricular scalp.
