Chondrodermatitis nodularis chronica helicis: Difference between revisions

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__NOTOC__
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{{CMG}};{{AE}} {{KRP}} {{KS}}
{{CMG}};{{AE}} {{KRP}} {{KS}}


{{SK}}Chondrodermatitis nodularis helicis, winkler disease, ear pressure sore
{{SK}}Chondrodermatitis nodularis helicis, winkler disease, ear pressure sore, chondrodermatitis nodularis auricularis


==Overview==
==Overview==
'''Chondrodermatitis nodularis chronica helicis''' (also known as "Chondrodermatitis nodularis helicis"<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref>{{rp|782}}) (CNH) is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the ear, occurring most often in men.<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref>{{rp|610}}
'''Chondrodermatitis nodularis chronica helicis''' (also known as "Chondrodermatitis nodularis helicis"<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref>{{rp|782}}) (CNCH) is a small, [[Nodular lesions|nodular]], [[Tenderness (medicine)|tender]], chronic [[Inflammation|inflammatory]] lesion occurring on the [[Helix (ear)|helix]] of the ear, occurring most often in men.<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref>{{rp|610}}


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==Historical Perspective[edit | edit source]==
==Historical Perspective[edit | edit source]==


*Chondrodermatitis nodularis chronica helicis was first discovered by Max Winkler, a dermatologist, in 1915, in a paper titled Knötchenförmige Erkrankung am Helix . <ref name="pmid21276202">{{cite journal| author=Wagner G, Liefeith J, Sachse MM| title=Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler. | journal=J Dtsch Dermatol Ges | year= 2011 | volume= 9 | issue= 4 | pages= 287-91 | pmid=21276202 | doi=10.1111/j.1610-0387.2011.07601.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276202  }}</ref><ref name="pmid27399947">{{cite journal| author=Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R| title=Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm. | journal=Dermatol Surg | year= 2016 | volume= 42 | issue= 10 | pages= 1125-34 | pmid=27399947 | doi=10.1097/DSS.0000000000000817 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27399947  }}</ref>
*Chondrodermatitis nodularis chronica helicis was first discovered by Max Winkler, a [[Dermatology|dermatologist]], in 1915, in a paper titled Knötchenförmige Erkrankung am Helix . <ref name="pmid21276202">{{cite journal| author=Wagner G, Liefeith J, Sachse MM| title=Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler. | journal=J Dtsch Dermatol Ges | year= 2011 | volume= 9 | issue= 4 | pages= 287-91 | pmid=21276202 | doi=10.1111/j.1610-0387.2011.07601.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276202  }}</ref><ref name="pmid27399947">{{cite journal| author=Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R| title=Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm. | journal=Dermatol Surg | year= 2016 | volume= 42 | issue= 10 | pages= 1125-34 | pmid=27399947 | doi=10.1097/DSS.0000000000000817 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27399947  }}</ref>
*in 1925, Foerster further developed the clinical, microscopic and treatment options for CNH.
*in 1925, Foerster further developed the clinical, microscopic and treatment options for CNCH.<ref name="pmid273999473">{{cite journal| author=Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R| title=Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm. | journal=Dermatol Surg | year= 2016 | volume= 42 | issue= 10 | pages= 1125-34 | pmid=27399947 | doi=10.1097/DSS.0000000000000817 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27399947  }}</ref>


==Pathophysiology==
==Pathophysiology==


*The pathophysiology remains unclear. It may be due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
*The pathophysiology of Chondrodermatitis nodularis chronica helicis remains unclear. It may be due to an inflammatory condition from chronic pressure on [[Helix (ear)|helix]] of the ear, but can occur on [[Anatomy of ear|anti-helix]] too.
*Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis.
*CNCH is seen mostly in elderly men. There are few cases seen in women and young, especially when CNCH is associated with [[Autoimmune disease|autoimmune]] or [[connective tissue disorders]]. <ref name="pmid29926164">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmid29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid28217474">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid27723195">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*CNH is seen mostly in elderly men. There are few cases seen in women and young, especially when associated with autoimmune or connective tissue disorders. <ref name="pmid29926164">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmid29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid28217474">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid27723195">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*The anatomy of ear pinna can contribute to the pathophysiology of CNCH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. <ref name="pmid29210713">{{cite journal| author=Elsensohn A, Getty S, Shiu J, de Feraudy S| title=Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis. | journal=Am J Dermatopathol | year= 2018 | volume= 40 | issue= 2 | pages= 139-141 | pmid=29210713 | doi=10.1097/DAD.0000000000001027 | pmc=6075668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29210713  }}</ref>
*The anatomy of ear pinna can contribute to the pathophysiology of CNH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. <ref name="pmid29210713">{{cite journal| author=Elsensohn A, Getty S, Shiu J, de Feraudy S| title=Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis. | journal=Am J Dermatopathol | year= 2018 | volume= 40 | issue= 2 | pages= 139-141 | pmid=29210713 | doi=10.1097/DAD.0000000000001027 | pmc=6075668 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29210713  }}</ref>
*In 2009, [[Perichondrium]] vasculitis theory explained the above anatomical features. Because of vasculature and subcutaneous tissue padding limitations, there is easy development of [[ischemia]] and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNCH. <ref name="pmid282174742">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231952">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*In 2009, Perichondrium vasculitis theory explained above anatomical features. Because of the vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNH. <ref name="pmid282174742">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231952">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><br />
*There could be a possibility of genetic relation to the disease, as observed in one case study of [[Twin|monozygotic twins.]] <ref name="pmid19175786">{{cite journal| author=Chan HP, Neuhaus IM, Maibach HI| title=Chondrodermatitis nodularis chronica helicis in monozygotic twins. | journal=Clin Exp Dermatol | year= 2009 | volume= 34 | issue= 3 | pages= 358-9 | pmid=19175786 | doi=10.1111/j.1365-2230.2008.02915.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19175786  }}</ref>
*On gross pathology, CNCH looks like any other sore/nodule. Microscopically, it shows [[Hyperkeratinization|hyperkeratosis]], [[parakeratosis]] with epithelial hyperplasia, dermal tissue damage with underlying [[Bone or cartilage mass|cartilage]] destruction and dermal vessel proliferation. <ref name="pmid277231953">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><ref name="pmid26925262">{{cite journal| author=Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J| title=Therapeutic Options of Chondrodermatitis Nodularis Helicis. | journal=Plast Surg Int | year= 2016 | volume= 2016 | issue=  | pages= 4340168 | pmid=26925262 | doi=10.1155/2016/4340168 | pmc=4748103 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26925262  }}</ref>
 
==Causes[edit | edit source]==
 
*Few causes of CNCH include chronic pressure, trauma, anatomic features, temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
 
*Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like [[Scleroderma (patient information)|scleroderma]], [[autoimmune thyroiditis]], [[Systemic lupus erythematosus|lupus]] erythematosus, or [[Polymyositis and dermatomyositis|dermatomyositis]]. <ref name="pmid299261642">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid282174743">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231954">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
 
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==Differentiating Chondrodermatitis nodularis chronica helicis from other Diseases[edit | edit source]==
 
*Chondrodermatitis nodularis chronica helicis can present as painful nodular lesion with central crust, so it must be differentiated from '''[[Basal cell carcinoma (patient information)|Basal cell carcinoma]]''' which is generally painless and with more vascularity.
*It must be differentiated from other diseases that cause a bump on the ear, such as:
 
:*[[Actinic Keratosis]]
:*[[Keratoacanthoma familial|Keratoacanthoma]]
:*[[Squamous cell carcinoma]]
:*[[Gout (patient information)|Gout]]<nowiki/>y tophi
 
==Epidemiology and Demographics[edit | edit source]==
 
*The disease is much common than it is reported.
 
===Age[edit | edit source]===
 
*CNCH is more commonly observed among patients aged 50-80 years old, but has been seen in young adults and children too. <ref name="pmid15811116">{{cite journal| author=Magro CM, Frambach GE, Crowson AN| title=Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury. | journal=J Cutan Pathol | year= 2005 | volume= 32 | issue= 5 | pages= 329-33 | pmid=15811116 | doi=10.1111/j.0303-6987.2005.00317.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15811116  }}</ref> Unilateral occurrence is more common.
 
===Gender[edit | edit source]===
 
*CNCH is seen mostly in elderly men, but may occur with women and children too.
 
===Race[edit | edit source]===
 
*There is no racial predilection for CNCH, but is seen more commonly in fair skinned with severe sun exposure.
 
==Risk Factors[edit | edit source]==
 
*Common risk factors in the development of CNCH are pressure, trauma, sun damage, and systemic conditions.
 
==Natural History, Complications and Prognosis[edit | edit source]==
 
*Early clinical features include just a painful sore. Spontaneous resolution is rare.
*Prognosis is generally good with treatment, although long term morbidity is common. Remissions can be seen when undertreated.
 
<br />


==Diagnosis==
==Diagnosis==
<br />
===History and Symptoms[edit | edit source]===
:*CNCH mostly presents as a spontaneously appearing round to oval tender nodule with raised edges on helix or anti-helix with a central crust/ulcer, commonly on ear of usually sleeping side, with nocturnal pain.
:*Like said, this is the most common presentation, but it can also present as bilateral lesion, or with diurnal pain.
:*It usually grows and becomes stable after reaching it's maximum size.
===Physical Examination===
===Physical Examination===
====Skin====
=====Ear=====
=====Ear=====
<gallery>
<gallery>
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File:Chondrodermatitis nodularis chronica helicis10.jpg|Chondrodermatitis nodularis chronica helicis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
File:Chondrodermatitis nodularis chronica helicis10.jpg|Chondrodermatitis nodularis chronica helicis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
</gallery>
<br />
===Laboratory Findings[edit | edit source]===
*There are no specific laboratory findings associated with CNCH.
*Skin biopsy may be necessary in conditions to differentiate it from carcinomatous lesions.
===Other Diagnostic Studies[edit | edit source]===
*Investigating for the systemic illness( autoimmune diseases, connective tissue diseases or chronic non-communicable diseases) for underlying associations to the disease is indicated in some studies.<ref name="pmid158111162">{{cite journal| author=Magro CM, Frambach GE, Crowson AN| title=Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury. | journal=J Cutan Pathol | year= 2005 | volume= 32 | issue= 5 | pages= 329-33 | pmid=15811116 | doi=10.1111/j.0303-6987.2005.00317.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15811116  }}</ref>
<br />
==Treatment[edit | edit source]==
Medical therapy and Surgery are the treatment options. Surgical procedures have less chance of recurrence of the disease.
===Medical/Conservative Therapy[edit | edit source]===
*The mainstay of therapy is to avoid/eradicate the triggers of CNCH, like pressure, trauma or solar damage. Pressure-relieving [[Prosthetic devices|prosthesis]] is the most cost-effective method. They are available in various forms like foam sponge or foam bandages, doughnut pillows<ref name="pmid17524165">{{cite journal| author=Sanu A, Koppana R, Snow DG| title=Management of chondrodermatitis nodularis chronica helicis using a 'doughnut pillow'. | journal=J Laryngol Otol | year= 2007 | volume= 121 | issue= 11 | pages= 1096-8 | pmid=17524165 | doi=10.1017/S0022215107008535 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17524165  }}</ref> or CNH pillows, or a home-made prosthesis. <ref name="pmid23205696">{{cite journal| author=Travelute CR| title=Self-adhering foam: a simple method for pressure relief during sleep in patients with chondrodermatitis nodularis helicis. | journal=Dermatol Surg | year= 2013 | volume= 39 | issue= 2 | pages= 317-9 | pmid=23205696 | doi=10.1111/dsu.12027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23205696  }}</ref><ref name="pmid19720252">{{cite journal| author=Sehgal VN, Singh N| title=Chondrodermatitis nodularis. | journal=Am J Otolaryngol | year= 2009 | volume= 30 | issue= 5 | pages= 331-6 | pmid=19720252 | doi=10.1016/j.amjoto.2008.04.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19720252  }}</ref><ref name="pmid15149500">{{cite journal| author=Moncrieff M, Sassoon EM| title=Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 892-4 | pmid=15149500 | doi=10.1111/j.1365-2133.2004.05961.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149500  }}</ref>
*Intralesional and topical steroids are reported to be used in treating CNCH as a second line, with a treatment success rate of 30-40%, especially with an initial benefit. <ref name="pmid277231955">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><ref name="pmid11966717">{{cite journal| author=Cox NH, Denham PF| title=Intralesional triamcinolone for chondrodermatitis nodularis: a follow-up study of 60 patients. | journal=Br J Dermatol | year= 2002 | volume= 146 | issue= 4 | pages= 712-3 | pmid=11966717 | doi=10.1046/j.1365-2133.2002.47047.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11966717  }}</ref><ref name="pmid151495002">{{cite journal| author=Moncrieff M, Sassoon EM| title=Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach. | journal=Br J Dermatol | year= 2004 | volume= 150 | issue= 5 | pages= 892-4 | pmid=15149500 | doi=10.1111/j.1365-2133.2004.05961.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15149500  }}</ref>
*Local [[collagen]] injections may provide cushioning and insulation, and corrects the deformity contour. <ref name="pmid2050461">{{cite journal| author=Greenbaum SS| title=The treatment of chondrodermatitis nodularis chronica helicis with injectable collagen. | journal=Int J Dermatol | year= 1991 | volume= 30 | issue= 4 | pages= 291-4 | pmid=2050461 | doi=10.1111/j.1365-4362.1991.tb04643.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2050461  }}</ref>
*Topical antibiotics are used for secondary bacterial infections.
*Carbon dioxide laser vaporizes the nodule and underlying cartilage. One study reports 92% cure rate with it. Immediate pain relief, and excellent cosmetic results. <ref name="pmid1757647">{{cite journal| author=Taylor MB| title=Chondrodermatitis nodularis chronica helicis. Successful treatment with the carbon dioxide laser. | journal=J Dermatol Surg Oncol | year= 1991 | volume= 17 | issue= 11 | pages= 862-4 | pmid=1757647 | doi=10.1111/j.1524-4725.1991.tb03275.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1757647  }}</ref>
*Nitroglycerin gel has been used by some to help reverse the cartilage necrosis by vasodilating arteriolar smooth muscles.<ref name="pmid23098568">{{cite journal| author=Yélamos O, Dalmau J, Puig L| title=Chondrodermatitis nodularis helicis: successful treatment with 2% nitroglycerin gel. | journal=Actas Dermosifiliogr | year= 2013 | volume= 104 | issue= 6 | pages= 531-2 | pmid=23098568 | doi=10.1016/j.ad.2012.07.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23098568  }}</ref><ref name="pmid26001657">{{cite journal| author=Sanz-Motilva V, Martorell-Calatayud A, Gutiérrez García-Rodrigo C, Hueso-Gabriel L, García-Melgares ML, Pelufo-Enguix C | display-authors=etal| title=The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis. | journal=Actas Dermosifiliogr | year= 2015 | volume= 106 | issue= 7 | pages= 555-61 | pmid=26001657 | doi=10.1016/j.ad.2015.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26001657  }}</ref>
*Photodynamic therapy improves blood flow to the lesion and provides cytotoxic effect on the lesion.<ref name="pmid28215445">{{cite journal| author=García-Malinis AJ, Turrión-Merino L, Pérez-García B, Saceda-Corralo D, Harto-Castaño A, Gilaberte Y| title=Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy. | journal=J Am Acad Dermatol | year= 2017 | volume= 76 | issue= 6 | pages= 1103-1108 | pmid=28215445 | doi=10.1016/j.jaad.2016.12.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28215445  }}</ref><ref name="pmid273999472">{{cite journal| author=Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R| title=Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm. | journal=Dermatol Surg | year= 2016 | volume= 42 | issue= 10 | pages= 1125-34 | pmid=27399947 | doi=10.1097/DSS.0000000000000817 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27399947  }}</ref>
===Surgery[edit | edit source]===
*Various surgical procedures have been implemented over years in the treatment of CNCH, which popularly include cartilage excision, curettage and wedge excision. Surgery is still the gold standard for the treatment of CNCH, with a success rate of 89%-96% with wedge excision.<ref name="pmid23120207">{{cite journal| author=Jacob K J, Satheesh S, Menon P, Saju KG| title=Winkler's disease. | journal=Indian J Otolaryngol Head Neck Surg | year= 2005 | volume= 57 | issue= 4 | pages= 323-4 | pmid=23120207 | doi=10.1007/BF02907700 | pmc=3451457 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23120207  }}</ref><ref name="pmid12437799">{{cite journal| author=de Ru JA, Lohuis PJ, Saleh HA, Vuyk HD| title=Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions. | journal=J Laryngol Otol | year= 2002 | volume= 116 | issue= 9 | pages= 677-81 | pmid=12437799 | doi=10.1258/002221502760237939 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12437799  }}</ref><ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/298059362">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref>
===Prevention[edit | edit source]===
*Effective measures for the primary prevention of CNCH include avoiding ear pressure/ pressure offloading techniques.
<br />


==References==
==References==

Latest revision as of 21:50, 28 July 2021

File:Chondrodermatitis.jpg
Chondrodermatitis helicis nodularis in a 67-year-old man.


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Karnik Raju Paila Bangaru, M.B.B.S.[2] Kiran Singh, M.D. [3]

Synonyms and keywords:Chondrodermatitis nodularis helicis, winkler disease, ear pressure sore, chondrodermatitis nodularis auricularis

Overview

Chondrodermatitis nodularis chronica helicis (also known as "Chondrodermatitis nodularis helicis"[1]:782) (CNCH) is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the ear, occurring most often in men.[2]:610


Historical Perspective[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis was first discovered by Max Winkler, a dermatologist, in 1915, in a paper titled Knötchenförmige Erkrankung am Helix . [3][4]
  • in 1925, Foerster further developed the clinical, microscopic and treatment options for CNCH.[5]

Pathophysiology

  • The pathophysiology of Chondrodermatitis nodularis chronica helicis remains unclear. It may be due to an inflammatory condition from chronic pressure on helix of the ear, but can occur on anti-helix too.
  • CNCH is seen mostly in elderly men. There are few cases seen in women and young, especially when CNCH is associated with autoimmune or connective tissue disorders. [6][7][8][9]
  • The anatomy of ear pinna can contribute to the pathophysiology of CNCH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. [10]
  • In 2009, Perichondrium vasculitis theory explained the above anatomical features. Because of vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNCH. [11][12]
  • There could be a possibility of genetic relation to the disease, as observed in one case study of monozygotic twins. [13]
  • On gross pathology, CNCH looks like any other sore/nodule. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. [14][15]

Causes[edit | edit source]

  • Few causes of CNCH include chronic pressure, trauma, anatomic features, temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.


Differentiating Chondrodermatitis nodularis chronica helicis from other Diseases[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis can present as painful nodular lesion with central crust, so it must be differentiated from Basal cell carcinoma which is generally painless and with more vascularity.
  • It must be differentiated from other diseases that cause a bump on the ear, such as:

Epidemiology and Demographics[edit | edit source]

  • The disease is much common than it is reported.

Age[edit | edit source]

  • CNCH is more commonly observed among patients aged 50-80 years old, but has been seen in young adults and children too. [20] Unilateral occurrence is more common.

Gender[edit | edit source]

  • CNCH is seen mostly in elderly men, but may occur with women and children too.

Race[edit | edit source]

  • There is no racial predilection for CNCH, but is seen more commonly in fair skinned with severe sun exposure.

Risk Factors[edit | edit source]

  • Common risk factors in the development of CNCH are pressure, trauma, sun damage, and systemic conditions.

Natural History, Complications and Prognosis[edit | edit source]

  • Early clinical features include just a painful sore. Spontaneous resolution is rare.
  • Prognosis is generally good with treatment, although long term morbidity is common. Remissions can be seen when undertreated.


Diagnosis


History and Symptoms[edit | edit source]

  • CNCH mostly presents as a spontaneously appearing round to oval tender nodule with raised edges on helix or anti-helix with a central crust/ulcer, commonly on ear of usually sleeping side, with nocturnal pain.
  • Like said, this is the most common presentation, but it can also present as bilateral lesion, or with diurnal pain.
  • It usually grows and becomes stable after reaching it's maximum size.

Physical Examination

Ear





Laboratory Findings[edit | edit source]

  • There are no specific laboratory findings associated with CNCH.
  • Skin biopsy may be necessary in conditions to differentiate it from carcinomatous lesions.

Other Diagnostic Studies[edit | edit source]

  • Investigating for the systemic illness( autoimmune diseases, connective tissue diseases or chronic non-communicable diseases) for underlying associations to the disease is indicated in some studies.[22]


Treatment[edit | edit source]

Medical therapy and Surgery are the treatment options. Surgical procedures have less chance of recurrence of the disease.

Medical/Conservative Therapy[edit | edit source]

  • The mainstay of therapy is to avoid/eradicate the triggers of CNCH, like pressure, trauma or solar damage. Pressure-relieving prosthesis is the most cost-effective method. They are available in various forms like foam sponge or foam bandages, doughnut pillows[23] or CNH pillows, or a home-made prosthesis. [24][25][26]
  • Intralesional and topical steroids are reported to be used in treating CNCH as a second line, with a treatment success rate of 30-40%, especially with an initial benefit. [27][28][29]
  • Local collagen injections may provide cushioning and insulation, and corrects the deformity contour. [30]
  • Topical antibiotics are used for secondary bacterial infections.
  • Carbon dioxide laser vaporizes the nodule and underlying cartilage. One study reports 92% cure rate with it. Immediate pain relief, and excellent cosmetic results. [31]
  • Nitroglycerin gel has been used by some to help reverse the cartilage necrosis by vasodilating arteriolar smooth muscles.[32][33]
  • Photodynamic therapy improves blood flow to the lesion and provides cytotoxic effect on the lesion.[34][35]

Surgery[edit | edit source]

  • Various surgical procedures have been implemented over years in the treatment of CNCH, which popularly include cartilage excision, curettage and wedge excision. Surgery is still the gold standard for the treatment of CNCH, with a success rate of 89%-96% with wedge excision.[36][37][38]

Prevention[edit | edit source]

  • Effective measures for the primary prevention of CNCH include avoiding ear pressure/ pressure offloading techniques.


References

  1. ↑ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. ↑ Wagner G, Liefeith J, Sachse MM (2011). "Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler". J Dtsch Dermatol Ges. 9 (4): 287–91. doi:10.1111/j.1610-0387.2011.07601.x. PMID 21276202.
  4. ↑ Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R (2016). "Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm". Dermatol Surg. 42 (10): 1125–34. doi:10.1097/DSS.0000000000000817. PMID 27399947.
  5. ↑ Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R (2016). "Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm". Dermatol Surg. 42 (10): 1125–34. doi:10.1097/DSS.0000000000000817. PMID 27399947.
  6. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  7. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID 29805936.
  8. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  9. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  10. ↑ Elsensohn A, Getty S, Shiu J, de Feraudy S (2018). "Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis". Am J Dermatopathol. 40 (2): 139–141. doi:10.1097/DAD.0000000000001027. PMC 6075668. PMID 29210713.
  11. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  12. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  13. ↑ Chan HP, Neuhaus IM, Maibach HI (2009). "Chondrodermatitis nodularis chronica helicis in monozygotic twins". Clin Exp Dermatol. 34 (3): 358–9. doi:10.1111/j.1365-2230.2008.02915.x. PMID 19175786.
  14. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  15. ↑ Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J (2016). "Therapeutic Options of Chondrodermatitis Nodularis Helicis". Plast Surg Int. 2016: 4340168. doi:10.1155/2016/4340168. PMC 4748103. PMID 26925262.
  16. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  17. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID https://www.ncbi.nlm.nih.gov/pubmed/29805936 Check |pmid= value (help).
  18. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  19. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  20. ↑ Magro CM, Frambach GE, Crowson AN (2005). "Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury". J Cutan Pathol. 32 (5): 329–33. doi:10.1111/j.0303-6987.2005.00317.x. PMID 15811116.
  21. ↑ 21.0 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 "Dermatology Atlas".
  22. ↑ Magro CM, Frambach GE, Crowson AN (2005). "Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury". J Cutan Pathol. 32 (5): 329–33. doi:10.1111/j.0303-6987.2005.00317.x. PMID 15811116.
  23. ↑ Sanu A, Koppana R, Snow DG (2007). "Management of chondrodermatitis nodularis chronica helicis using a 'doughnut pillow'". J Laryngol Otol. 121 (11): 1096–8. doi:10.1017/S0022215107008535. PMID 17524165.
  24. ↑ Travelute CR (2013). "Self-adhering foam: a simple method for pressure relief during sleep in patients with chondrodermatitis nodularis helicis". Dermatol Surg. 39 (2): 317–9. doi:10.1111/dsu.12027. PMID 23205696.
  25. ↑ Sehgal VN, Singh N (2009). "Chondrodermatitis nodularis". Am J Otolaryngol. 30 (5): 331–6. doi:10.1016/j.amjoto.2008.04.001. PMID 19720252.
  26. ↑ Moncrieff M, Sassoon EM (2004). "Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach". Br J Dermatol. 150 (5): 892–4. doi:10.1111/j.1365-2133.2004.05961.x. PMID 15149500.
  27. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  28. ↑ Cox NH, Denham PF (2002). "Intralesional triamcinolone for chondrodermatitis nodularis: a follow-up study of 60 patients". Br J Dermatol. 146 (4): 712–3. doi:10.1046/j.1365-2133.2002.47047.x. PMID 11966717.
  29. ↑ Moncrieff M, Sassoon EM (2004). "Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach". Br J Dermatol. 150 (5): 892–4. doi:10.1111/j.1365-2133.2004.05961.x. PMID 15149500.
  30. ↑ Greenbaum SS (1991). "The treatment of chondrodermatitis nodularis chronica helicis with injectable collagen". Int J Dermatol. 30 (4): 291–4. doi:10.1111/j.1365-4362.1991.tb04643.x. PMID 2050461.
  31. ↑ Taylor MB (1991). "Chondrodermatitis nodularis chronica helicis. Successful treatment with the carbon dioxide laser". J Dermatol Surg Oncol. 17 (11): 862–4. doi:10.1111/j.1524-4725.1991.tb03275.x. PMID 1757647.
  32. ↑ Yélamos O, Dalmau J, Puig L (2013). "Chondrodermatitis nodularis helicis: successful treatment with 2% nitroglycerin gel". Actas Dermosifiliogr. 104 (6): 531–2. doi:10.1016/j.ad.2012.07.016. PMID 23098568.
  33. ↑ Sanz-Motilva V, Martorell-Calatayud A, Gutiérrez García-Rodrigo C, Hueso-Gabriel L, García-Melgares ML, Pelufo-Enguix C; et al. (2015). "The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis". Actas Dermosifiliogr. 106 (7): 555–61. doi:10.1016/j.ad.2015.04.004. PMID 26001657.
  34. ↑ García-Malinis AJ, Turrión-Merino L, Pérez-García B, Saceda-Corralo D, Harto-Castaño A, Gilaberte Y (2017). "Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy". J Am Acad Dermatol. 76 (6): 1103–1108. doi:10.1016/j.jaad.2016.12.019. PMID 28215445.
  35. ↑ Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R (2016). "Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm". Dermatol Surg. 42 (10): 1125–34. doi:10.1097/DSS.0000000000000817. PMID 27399947.
  36. ↑ Jacob K J, Satheesh S, Menon P, Saju KG (2005). "Winkler's disease". Indian J Otolaryngol Head Neck Surg. 57 (4): 323–4. doi:10.1007/BF02907700. PMC 3451457. PMID 23120207.
  37. ↑ de Ru JA, Lohuis PJ, Saleh HA, Vuyk HD (2002). "Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions". J Laryngol Otol. 116 (9): 677–81. doi:10.1258/002221502760237939. PMID 12437799.
  38. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID https://www.ncbi.nlm.nih.gov/pubmed/29805936 Check |pmid= value (help).


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de:Chondrodermatitis nl:Chondrodermatitis nodularis helicis

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