Chondrodermatitis nodularis chronica helicis: Difference between revisions

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==Diagnosis==
==Diagnosis==
<br />
<br />
===Diagnostic Criteria[edit | edit source]===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]


===History and Symptoms[edit | edit source]===
===History and Symptoms[edit | edit source]===


*[Disease name] is usually asymptomatic.
:*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 on usually sleeping side, with nocturnal pain.
*Symptoms of [disease name] may include the following:
:*Like said, this is 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.
:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]


===Physical Examination===
===Physical Examination===
====Skin====
=====Ear=====
=====Ear=====
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<gallery>
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</gallery>
</gallery>


=== Laboratory Findings[edit | edit source] ===


* There are no specific laboratory findings associated with [disease name].


* A [positive/negative] [test name] is diagnostic of [disease name].
* An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
* Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].


=== Other Diagnostic Studies[edit | edit source] ===
There are no other diagnostic studies associated with [disease name].


OR


[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
<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>


== Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3]. ==
<br />
<br />


== Treatment[edit | edit source] ==
==Treatment[edit | edit source]==
 
=== Medical Therapy[edit | edit source] ===


* There is no treatment for [disease name]; the mainstay of therapy is supportive care.
===Medical Therapy[edit | edit source]===


* The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].


=== Surgery[edit | edit source] ===
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].


* Surgery is the mainstay of therapy for [disease name].
===Surgery[edit | edit source]===
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].


=== Prevention[edit | edit source] ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].


* There are no primary preventive measures available for [disease name].
===Prevention[edit | edit source]===


* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
*Effective measures for the primary prevention of CNCH include avoiding ear pressure/ pressure offloading techniques.


* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


<br />
<br />


== References ==
==References==
{{reflist|2}}
{{reflist|2}}


Revision as of 17:56, 28 July 2021

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


1_ 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.

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. [5][6][7][8]
  • 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. [9]
  • 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 CNCH. [10][11]
  • There could be a possibility of genetic relation to disease, as observed in a case of monozygotic twins, but not studied enough to make a point. [12]
  • On gross pathology, CNCH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. [13][14]

Causes[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis may be caused 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.
  • 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. [15][16][17][18]


Differentiating [disease name] 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:
  • Actinic Keratosis
  • Keratoacanthoma
  • Squamous cell carcinoma
  • Gouty 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. [19] 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 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 very 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 on usually sleeping side, with nocturnal pain.
  • Like said, this is 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.[21]


Treatment[edit | edit source]

Medical Therapy[edit | edit source]

  • There is no treatment for [disease name]; the mainstay of therapy is supportive care.
  • The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action 1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery[edit | edit source]

  • Surgery is the mainstay of therapy for [disease name].
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
  • [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention[edit | edit source]

  • Effective measures for the primary prevention of CNCH include avoiding ear pressure/ pressure offloading techniques.
  • Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  12. ↑ 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.
  13. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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).
  17. ↑ 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.
  18. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  19. ↑ 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.
  20. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 "Dermatology Atlas".
  21. ↑ 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.


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