Chondrodermatitis Nodularis Research Articles

Pediatric Chondrodermatitis Nodularis Helicis

Chondrodermatitis nodularis helicis (CNH) is a rare condition of the pinna affecting mainly adults. A pediatric case of this condition is presented in the current report, and the literature of pediatric CNH is reviewed.

Neural hyperplasia in chondrodermatitis nodularis chronica helicis

Chondrodermatitis nodularis chronica helicis (CNCH) is a common condition characterized by tender nodules of the helix, of uncertain mechanism. The pain is not explained by current physiopathological hypotheses. We sought to investigate possible nerve hyperplasia in CNCH. Thirty-seven cases of clinically typical CNCH were submitted to conventional microscopy after surgical excision and analyzed with immunohistochemistry using PS100 and neurofilament antibodies. As controls, we investigated 25 tumors of the ear with the same methods. Large nerves (>0.1 mm in diameter) were seen in 8 of 37 cases; these were close to the cartilage or at the upper part of the ulceration. Increased numbers of small nerve sections (0.01-0.06 mm in diameter) were seen in 35 of 37 cases, with more than 20 sections per low-power field in 18 cases. Nerve hyperplasia was not observed in tumors of the ear, even in ulcerated cases. Hypothesis based on morphologic observations. Nerve hyperplasia is present in CNCH, but is often masked by intense vascular and inflammatory reactions. This finding may explain the induction of pain by light pressure, whereas ulcerated auricular malignant tumors are generally painless. Certain authors believe that CNCH is an equivalent of prurigo nodularis, which interestingly also shows nerve hyperplasia.

Narrow Elliptical Skin Excision and Cartilage Shaving for Treatment of Chondrodermatitis Nodularis

Surgical excision remains the hallmark of therapy for chondrodermatitis nodularis chronica (CNC). Although excision is generally successful, recurrence at the edge of the excised nodule is well recognized. To analyze the clinical features and the recurrence rate of patients with CNC treated with elliptical excision of the papule and removal of the underlying cartilage. Seventy-four outpatients with CNC, 52 men and 22 women, were retrospectively analyzed. A narrow elliptical excision of the papule followed by a slice of the underlying cartilage were carried out with local anesthetic. Cartilage spikes were trimmed carefully shaping a smooth contour from the normal helical rim to the defect. Good cosmetic results were obtained in all patients. The median follow-up for helical and antihelical lesions were 54 and 50 months, respectively. The global recurrence rate was 13.5% and ranged from 10.6 to 37.5% for helical and antihelical lesions, respectively. We recommend this surgical procedure because it has been shown to be as efficient as other methods and probably faster to perform.

Narrow Elliptical Skin Excision and Cartilage Shaving for Treatment of Chondrodermatitis Nodularis

BACKGROUND Surgical excision remains the hallmark of therapy for chondrodermatitis nodularis chronica (CNC). Although excision is generally successful, recurrence at the edge of the excised nodule is well recognized. OBJECTIVE To analyze the clinical features and the recurrence rate of patients with CNC treated with elliptical excision of the papule and removal of the underlying cartilage. DESIGN Seventy-four outpatients with CNC, 52 men and 22 women, were retrospectively analyzed. A narrow elliptical excision of the papule followed by a slice of the underlying cartilage were carried out with local anesthetic. Cartilage spikes were trimmed carefully shaping a smooth contour from the normal helical rim to the defect. RESULTS Good cosmetic results were obtained in all patients. The median follow-up for helical and antihelical lesions were 54 and 50 months, respectively. The global recurrence rate was 13.5% and ranged from 10.6 to 37.5% for helical and antihelical lesions, respectively. CONCLUSIONS We recommend this surgical procedure because it has been shown to be as efficient as other methods and probably faster to perform.

Conditions affecting the ears

A pictorial presentation of conditions affecting the ears including bruised pinna, chondrodermatitis nodularis helicis chronicus, contact dermatitis, embedded studs, intradermal naevus and pyogenic granuloma.

Winkler's disease

Winkler's disease otherwise known as chondrodermatitis nodularis chronica helices (CNHC) is characterized by a painful persistent erythematous nodule, mostly located at the rim of helix of pinna. Occurs mostly in men over 40 years of age. Standard therapy is by local excision or carbon dioxide laser vaporization. Recurrence is frequent.

Chondrodermatitis nodularis helicis as a marker of internal syndromes associated with microvascular injury

Chondrodermatitis nodularis helicis (CNH) is held to be an idiopathic degenerative process involving the upper dermis of the auricular rim. Chondrodermatitis typically occurs in elderly men where associations with underlying trauma and sun exposure have been postulated as potential inciting triggers. Its association as a marker of systemic disease is not well established. We describe 24 patients with CNH, in whom there were also significant underlying diseases largely associated with vascular injury including those of immune-based etiology and/or conditions which have been previously linked with granuloma annulare, another necrobiotic process of collagen. These patients with concomitant systemic disease were characteristically younger compared to the classic demographics described for CNH. In some cases, chondrodermatitis may represent an ischemic necrobiotic disorder of collagen, potentially defining an important sign of underlying systemic disease in younger patients.

Porokeratosis‐like Changes in Chondrodermatitis Nodularis Helicis:Consequence or Coincidence?

Background: Chondrodermatitis nodularis helicis (CNH) is a condition with known predisposing factors, but of unknown etiology. A variety of opinions exist as to the cause of this condition, without consensus. Design: We reviewed 111 cases of CNH from 103 patients at our laboratory. p53 immunohistochemical staining, which is over expressed in basilar epidermal cells of porokeratosis, was performed in a representative sample of CNH cases. Histologic changes characteristic of porokeratosis were qualified as a 1) parakeratotic column of keratinocytes 2) an attenuated to absent granular layer, and 3) adjacent or underlying dyskeratosis of keratinocytes, present in columns or aggregates. Results: Porokeratosis‐like changes were identified in 77 of 111 cases. p53 staining was noncontributory. Conclusion: The presence of these porokeratosis‐like changes in 69% of cases is intriguing. It is not clear whether or not this could possibly represent a causative mechanism or, perhaps, an otherwise coincident histologic change. The presence of porokeratosis‐like changes in CNH provides a possible hypothesis in relationship to its etiology, at the very least, it could provide some histologic clue as to the presence of this deep dermal process in superficial biopsies.

Treatment of chondrodermatitis nodularis helicis: A new surgical technique

Objectives: Chondrodermatitis nodularis helicis, or painful nodule of the ear, is an uncommon benign lesion that is seen and treated by the otolaryngologists and dermatologists. Surgical treatment by wide excision with removal of underlying cartilage is generally recommended. Recurrences usually occur because of inappropriate removal of the cartilage leading to painful nodules at the excised margins. This new surgical technique significantly reduces the recurrence of CDNH. Methods: We use a 4 mm disposable curette to get this desired effect. The nodule is removed along with underlying cartilage through an elliptical incision with a number 15 surgical blade. The rest of the cartilage is curetted and smoothened with a disposable curette until no sharp edges are left behind. Skin is sutured over the defect. Results: This results in excellent cosmetic appearance of the pinna. Also it significantly reduces the recurrence of chondrodermatitis nodularis helicis. Conclusion: Our surgical technique combines minimal skin removal and adequate cartilage resection, thus describing a simple surgical technique, avoiding the need for more elaborate and deforming surgical procedures. This technique also significantly reduces the risk of a recurrence. Therefore, we recommend this safe and simple technique to other surgeons, who treat patients with chondrodermatitis nodularis helicis.

Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach

Chondrodermatitis nodularis chronica helicis (CNCH) is usually treated by surgical excision, but is prone to recurrence. To examine whether CNCH could be treated nonsurgically using a home-made, pressure-relieving prosthesis. A retrospective comparison was made of the outcome in 41 subjects treated surgically and 15 treated nonsurgically between 1999 and 2001. Thirteen of the 15 patients (87%) treated nonsurgically were healed at follow-up after 1 month of conservative treatment and so have avoided surgery to date. In contrast, the recurrence rate of the surgically treated group was 14 of 41 (34%) patients. As a result of this study, we recommend that patients presenting with CNCH be managed conservatively in the first instance.

Modified Surgical Excision for the Treatment of Chondrodermatitis Nodularis

BACKGROUND Chondrodermatitis nodularis (CN) is a common inflammatory condition of the ear that produces a painful papule or nodule on the helix or antihelix. Excision of the cartilage alone has been demonstrated to be therapeutically and cosmetically effective. OBJECTIVE To simplify the surgical procedure. METHOD We used two steps to refine the classic technique. We excised a narrow ellipse of skin over the nodule and replaced cold steel dissection by injecting normal saline into the plane of cleavage between the skin and cartilage. RESULTS These two refinements resulted in maintaining the clinical and cosmetic efficacy and simplified the surgical technique. CONCLUSION The addition of an elliptical excision over the nodule and the use of hydrodissection in the surgical treatment of chondrodermatitis nodularis were of benefit to both the patient and the surgeon.

Modified surgical excision for the treatment of chondrodermatitis nodularis.

Chondrodermatitis nodularis (CN) is a common inflammatory condition of the ear that produces a painful papule or nodule on the helix or antihelix. Excision of the cartilage alone has been demonstrated to be therapeutically and cosmetically effective. To simplify the surgical procedure. We used two steps to refine the classic technique. We excised a narrow ellipse of skin over the nodule and replaced cold steel dissection by injecting normal saline into the plane of cleavage between the skin and cartilage. These two refinements resulted in maintaining the clinical and cosmetic efficacy and simplified the surgical technique. The addition of an elliptical excision over the nodule and the use of hydrodissection in the surgical treatment of chondrodermatitis nodularis were of benefit to both the patient and the surgeon.

Juvenile Chondrodermatitis Nodularis Helicis: A Case Report and Literature Review

Chondrodermatitis nodularis helicis (CNH) is a disorder that affects adults. Only one case of juvenile CNH has been reported, in an 8-year-old child who suffered from dermatomyositis. We report another child with juvenile CNH who was not afflicted with dermatomyositis or other systemic disorders. The clinical and histologic evaluations demonstrated CNH on the helix of the right ear in a 16-year-old Caucasian girl who was otherwise healthy. Serologic analysis ruled out an underlying autoimmune disorder. We conclude that juvenile CNH is extremely rare and may occur in patients without dermatomyositis or other systemic disorders.

Bilateral chondrodermatitis nodularis chronica helicis on the free border of the helix in a woman

Chondrodermatitis nodularis chronica helicis is characterized by the presence of small, intensely painful nodules on the free border of the helix of the ear with unknown origin. The lesion is typically localized unilaterally on the right ear. Pressure and trauma may play a role.

Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions.

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear. In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease. Reports on this technique claim excellent cosmetic results with only a small chance of recurrence. In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports. Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery. The authors recommend this safe and simple technique to other physicians who treat patients with CDN.

A clutch of new syndromes

In the ENT subsection of his paper (March 2002 JRSM1) Dr Le Fanu quotes a patient's description of sore ear, affecting a ‘line of rigid muscle alongside the soft outer ear’. Whilst there exist fine muscles on the posterior, or cranial, surface the skin adheres closely to the anterior, or lateral, surface of the auricle, which has very little subcutaneous tissue2. Seemingly the patient refers to a fold in the elastic cartilage known as the antihelix. The symptoms in this case closely resemble those of chondrodermatitis nodularis helicis. Histologically such lesions show focal degenerative change with surrounding perichondritis and overlying hyperkeratosis and acanthosis3. The usual treatment is simple excision, but a patient who declined surgery later told me how he had invented his own method to avoid discomfort at night—cutting a hollow into his foam pillow to reduce pressure on the ear.

Connective tissue tumors.

Connective tissue consists of collagen, elastic fibers and ground substances produced by fibrocytes. These cells are usually spindle-shaped with slender nuclei and bipolar cytoplasmic extensions. Apart from labeling for vimentin and variable reactivity for factor XIIIa and CD34, fibrocytes are immunonegative. Electron microscopy reveals prominent endoplasmic reticulum, but is otherwise indistinct. Lesions with fibrocytic differentiation can be divided into five categories: scars, keloids, dermatofibromas, nodular fasciitis, and superficial fibromatoses are inflammatory lesions. Thereby, dermatofibromas and their subcutaneous/deep soft tissue counterpart nodular fasciitis can present with a wide variety of clinicopathologic variants which may be misinterpreted as malignancies. Prurigo nodularis, chondrodermatitis nodularis helicis, acanthoma fissuratum, and knuckle pads are hyperplasias; fibroma molle, fibrous papules, connective tissue nevi, and elastofibroma are hamartomas; and fibroma of tendon sheath, pleomorphic fibroma, and giant cell tumor of tendon sheath are benign neoplasms. Deep fibromatoses, dermatofibrosarcoma protuberans, giant cell fibroblastoma, giant cell angiofibroma, hyalinizing spindle cell tumor with giant rosettes, solitary fibrous tumor, myxofibrosarcoma, low-grade fibromyxoid sarcoma, acral myxoinflammatory fibroblastic sarcoma, and classical fibrosarcoma, are malignant neoplasms, that is fibrosarcomas of variable malignant potential. Lesions dominated by myocytes/ myofibroblasts, e.g. cutaneous myofibroma/infantile myofibromatosis, or by macrophages, e.g. xanthogranulomas, are not part of this chapter.

Cartilage Removal Alone for Treating Chondrodermatitis Nodularis Helices

Chondrodermatitis nodularis helicis (CNH) has been treated with a variety of approaches -- intralesional corticosteroids, special doughnut pillows for

The long-term results of cartilage removal alone for the treatment of chondrodermatitis nodularis.

Cartilage excision alone has been demonstrated to be an effective technique in the treatment of chondrodermatitis nodularis (CDN), and in the short term is associated with an 80% cure rate. The objective of this study was to demonstrate that long-term disease control could be achieved using this surgical technique. Set in three hospital dermatology departments, 94 patients with CDN affecting the helix and antihelix were contacted by postal questionnaire at least 6 months after surgery. Replies were received from 77; 11 patients had died and six could not be traced. The main outcome measure was the identification of those patients in remission and those with disease recurrence. Sixty-two helix lesions were followed up for a mean of 52 months (range 8-99). There was recurrence in 10 patients (all men; 16%). Twenty antihelix lesions were followed up for a mean of 55 months (range 8-93). There was recurrence in five patients (all women; 25%). In conclusion, this study confirms that only cartilage needs to be excised for the long-term effective treatment of CDN. The only relevant aetiological factor identified was that all except one patient slept on the same side as the CDN. We believe that pressure on the ear during sleep causes CDN. This is most evident on the most protuberant part of the ear.

Chondrodermatitis nodularis chronica helicis.

Chondrodermatitis nodularis chronica helicis is a painful nodule of the external ear. These uncommon lesions are most often encountered on the helix in white men older than 40 years, although they also rarely occur on the antihelix in women. The lesions frequently present with exquisite tenderness that interferes with sleep. While the cause of this dermal inflammatory process is not known, long-term trauma or sun damage may play a role. Recurrences often complicate treatment if all sites of inflammation are not eradicated. Surgical treatment is generally recommended, either by wide excision or by deep shave and treatment of the underlying cartilage.