Chondrodermatitis nodularis nasi.

Chondrodermatitis nodularis helicis is a relatively common ulcerative, inflammatory condition affecting the skin, and cartilage of the ear. We present a case of chondrodermatitis affecting the skin and cartilage of the nose, designated chondrodermatitis nodularis nasi. Clinically, chondrodermatitis presents as a singular, painful, ulcerated papule or nodule that results from prolonged pressure, trauma, sun exposure, or vascular compromise. The clinical features resemble those seen in skin cancer, and a biopsy is often required to secure the diagnosis. Histopathologic analysis of chondrodermatitis demonstrates a central ulcer, beneath which there is fibrinoid necrosis of the dermis and inflammatory infiltrates. The ulcer is bordered by pseudoepitheliomatous hyperplasia with underlying granulation tissue. In addition to a clinical and morphologic description of chondrodermatitis nodularis nasi, a discussion of etiological factors and differential diagnoses is included. Increased recognition and reporting of the condition will allow for the exploration of optimal treatment strategies.

Pediatric chondrodermatitis nodularis helicis (CNH) in a child with Beckwith-Wiedemann syndrome (BWS).

Chondrodermatitis nodularis helicis is an idiopathic degenerative process that presents as a painful nodule, papule, or ulcer on the helix or antihelix. It predominantly affects adults and is thought to be associated with trauma to the ear. We describe a case of pediatric chondrodermatitis nodularis helicis occurring in a child with a history of Beckwith-Wiedemann syndrome that was successfully treated with an excisional biopsy and relief from a recurrent source of pressure on the ear.

Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy.

BACKGROUND: Therapies used to treat chondrodermatitis nodularis helicis (CNH), such as surgical excision, pressure relief, or topical steroids report varying degrees of success. OBJECTIVE: We evaluated the response and safety of methyl aminolevulinate (MAL) photodynamic therapy (PDT) in CNH. METHODS: This retrospective, observational study performed at the University Hospital Ramon y Cajal (Madrid, Spain) and Hospital San Jorge (Huesca, Spain) included all patients diagnosed with CNH and treated with MAL-PDT from 2008 to 2015. Treatment sites were prepared and irradiated as per the conventional MAL-PDT procedure. RESULTS: Patients underwent a mean of 2.3 sessions with between-session intervals ranging from 15 days to 1 month. A complete response to PDT was observed in 33 patients (76.7%), who experienced pain relief and resolution of the inflammatory nodule. Lesion recurrence was recorded in 10 patients (23.3%) during the mean follow-up period of 20 months. Receiving ≥2 PDT sessions was significantly associated with a good response (26/28, 93% success rate, P = .003). LIMITATIONS: Some limitations of the study are the lack of an established between-session interval, the absence of evaluation of curettage effectiveness and the limited sample size. DISCUSSION: The results support the view that PDT is a promising treatment approach for CNH.

The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis.

BACKGROUND AND OBJECTIVE: Chondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH. MATERIAL AND METHODS: We performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale. RESULTS: Of the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases. CONCLUSION: Topical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.

Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: a new therapeutic option.

Chondrodermatitis nodularis helicis (CNH) is an inflammatory process that affects the skin and cartilage of the ear. At present, there are many treatment options, although they are not always effective. Based on previous studies where nitroglycerin 2% gel was used, we propose the use of nitroglycerin patches. The purpose of this study was to evaluate the effectiveness of nitroglycerin patches in treating CNH. We performed a prospective study in 11 patients diagnosed with CNH treated with nitroglycerin patches 5 mg, 12 hours a day for 2 months. The therapeutic effectivity was determined by the improvement in the appearance and symptoms of the lesion. Seven of 11 patients (63.6%) had a complete response. One of 11 patients (9%) did not respond completely and surgical treatment was performed. Two of 11 patients (18.1%) stopped the treatment because of headache. One of 11 patients (9%) did not complete the treatment because the said patient forgot to apply the patch every night. Transdermal nitroglycerin has demonstrated efficacy in the treatment of the symptoms and lesional appearance of CNH noninvasive manner. The success rate is comparable with other published methods and the rate of adverse effects is acceptable.

[Chondrodermatitis nodularis chronica helicis: a descriptive study of 99 patients]. / Nodule douloureux de l'oreille : étude descriptive de 99 cas.

BACKGROUND: Painful nodule of the ear was described at the start of the 20th century as a form of chronic chondrodermatitis nodularis helicis (CNH). It comprises a painful erythematous papule or nodule appearing on the ear and adhering to cartilage, and which may or may not have a central scab. The aim of this study was to describe the clinical characteristics of CNH as well as the population currently affected by such lesions, and to identify predisposing factors. The secondary aim was to describe treatments commonly used in private dermatological practice and to examine their efficacy. MATERIALS AND METHODS: Questionnaires were sent out to private dermatologists belonging to the Association d'information post-universitaire en dermato-vénérologie de Strasbourg [Association for post-university information in dermatology-venerology] in Strasbourg. Patients were included in the study if they consulted for CNH, clinically diagnosed as such by the dermatologist. The questionnaire was used to analyze the age, gender and phototype of patients, as well as pain assessed on a numeric scale, duration, site, supposed trigger factors, treatment and outcome after treatment. RESULTS: A total of 99 patients was included by 27 dermatologists between March 2010 and October 2011, mainly men (sex-ratio: 1.6). The mean age was 65 years. Patients had no significant previous history. Pain was moderate in 23 patients, severe in 59 and unbearable in 14; in most patients it was brought on by provocation (78 patients). The right ear was affected in 48 patients and the left ear in 39. CNH had been present for a mean 14 months. The most common site was the upper/horizontal section and the angle of the helix of the ear (62 patients). Exposure to sunlight or to cold were the predisposing factors most frequently mentioned (56 patients). Medical treatment was given for 52 patients, and resulted in cure of almost half of this population. Surgery was performed in 34 patients, with only one case of relapse. DISCUSSION: Our study shows that the current population of subjects with CNH is comparable with that described in the literature. New professional and technological apparatus appearing in recent decades (hearing aids, headphones and in-ear headphones, crash helmets) result in continual trauma to the ear and could favour the onset of CNH. The treatment most commonly given by dermatologists is non surgical, which may be effective in certain patients. Analgesic treatment and removal of factors responsible for trauma are also important in management.

Spectrum of comorbid autoimmune diseases in patients with chondrodermatitis nodularis helicis: a 17-year retrospective study of 215 patients in Asturias, northern Spain

Background: The cause of chondrodermatitis nodularis helicis (CN) (Winkler's disease) is unknown, but potential associations with autoimmune diseases have been suggested in case reports, however, studies with large case series are lacking. Objectives: To clarify the frequency of chronic inflammatory and autoimmune diseases (CADs), and associated gender and age distribution, in a large cohort of patients with CN. Materials & Methods: The frequency of CADs (systemic and cutaneous) was assessed in 215 patients (65.1% males and 34.9% females; median age: 69.6 years) with a histopathological diagnosis of CN (2000-2017). Endocrine diseases were not included. Statistical analysis included Fisher's exact test and multivariate logistic regression analysis. Results: Twenty different CADs were diagnosed in 15.34% patients with CN. The most frequent were polymyalgia rheumatica (six patients), psoriasis (four patients, one with psoriatic arthritis), rheumatoid arthritis (three patients), CREST syndrome (two patients), vitiligo (two patients), and chronic dermatitis (two patients). Several CADs were strongly associated with tobacco smoking. Systemic CADs were more frequent in females (OR: 3.814; CI 1.513-9.613; p = 0.005; multivariate logistic regression analysis). Differences according to age at onset were not significant. Conclusion: We characterize, for the first time, the spectrum of CADs as well as age and gender distribution in patients with CN based on the largest cohort of patients to date. The possible accumulation of different disorders that are strongly associated with tobacco smoking (Buerger's disease, pulmonary Langerhans cell histiocytosis, rheumatoid arthritis, Lupus erythematosus, and others) merits further investigation, but the rarity of some of them makes this challenging.

Dermoscopy of chondrodermatitis nodularis helicis.

Chondrodermatitis nodularis helicis (CNH) is a benign auricular disease whose differentiation with nonpigmented tumors is mandatory. Clinical characteristics of CNH are well known, but there is no information about the dermoscopic features that could help differentiate CNH from squamous cell carcinoma and other non-melanoma skin cancers. To describe the dermoscopic appearance of CNH and to formulate a differential diagnostic model, we conducted  a retrospective, single center, observational dermoscopic study on a sample of 189 biopsy-proven lesions: 25 CNH; 26 squamous cell carcinomas; 62 basal cell carcinomas and 76 other benign and malignant tumors. Univariate and multivariate analyses were conducted by logistic regression. The most significant dermoscopic finding for CNH was a peculiar global configuration (daisy pattern), consisting of white thick lines, radially arranged, converging to a central rounded yellow/brown clod (an erosion covered by keratin or sero-crust). This pattern achieved 92 and 98% of specificity for discriminating CNH with squamous cell carcinoma and basal cell carcinoma, respectively. In conclusion, dermoscopy is valuable for the diagnosis of CNH as a first screening tool because of a consistent global dermoscopic configuration (daisy pattern), consisting of radially arranged white thick lines surrounding a central rounded yellow/brown clod.