Chondrodermatitis nodularis helicis as a marker of internal disease [corrected] associated with microvascular injury

Coronavirus disease 2019 pandemic related chondrodermatitis nodularis helicis: the role of masks

BACKGROUND

Chondrodermatitis nodularis helicis is a benign, but painful inflammatory condition of the ear, characterised by a tender nodule located on the helix or antihelix. This study aimed to investigate the occurrence of chondrodermatitis nodularis helicis associated with the use of coronavirus disease 2019 masks during the pandemic.

METHOD

A retrospective single-centre study was performed from February 2020 to February 2022 in the Maxillo-Facial Unit at the University Hospital of Siena, Italy.

RESULTS

During the indexed period, 11 patients were affected by chondrodermatitis nodularis helicis. All patients wore a mask for more than 8 hours a day, every day for several months.

CONCLUSION

Although there is no certain proof of the correlation between masks and chondrodermatitis nodularis helicis, an increase in the incidence of this condition was highlighted in our single-centre experience in the pandemic period. The prolonged use of coronavirus disease 2019 masks may explain this correlation.

Therapeutic Options of Chondrodermatitis Nodularis Helicis

Chondrodermatitis Nodularis Helicis is a benign inflammatory process affecting the skin and cartilage of the ear. It typically presents as a painful nodule surrounded by an area of erythema and often prevents the patient from sleeping on the affected side. Many treatments have been described in the literature, but the condition is prone to recurrence. A literature search was performed in order to identify the best possible treatment. Fifty-eight articles were included, describing and investigating nonsurgical as well as surgical treatment modalities. Large prospective, controlled, and randomised long-term studies are lacking, but based on the available literature, we recommend starting with a conservative approach using decompression devices. Simple surgical procedures should only be used if conservative measures fail.

Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler

The article on chondrodermatitis nodularis chronica helicis summarizes various clinical pictures and differential diagnoses of this entity. This lesion is usually characterized by a solid or cystic nodule but ulcerations or crusts may also occur. The most common differential diagnoses include benign or malignant tumours, which are often confused with chondrodermatitis nodularis chronica helicis. The characteristic pain associated with this condition may serve as an important diagnostic clue in order to rule out other differential diagnoses. The therapy of chondrodermatitis nodularis chronica helices encompasses several conservative as well as surgical treatment options.

Chondrodermatitis nodularis chronica helicis - a conservative therapeutic approach by decompression

BACKGROUND

Chondrodermatitis nodularis chronica helicis is a rather common condition which substantially affects quality of life causing pain and sleeping disturbances. Surgical treatment is connected with a tendency to recurrence. Mechanical pressure is probably the main etiological factor.

PATIENTS AND METHODS

A prospective study was performed with 18 patients that were offered a non-surgical treatment using a self-made bandage of foam plastic which they applied during the night. Of these, 12 performed the treatment including follow-up; 6 patients initially also consented, but they did not return after the initial visit.

RESULTS

11 patients reported substantial reduction of pain within the first month; after an average of 1.75 months they were free of pain. All 8 patients with initial sleeping problems caused by pain reported undisturbed sleep after only one month. In 11 patients the lesions receded satisfactorily, in 9 patients completely, in 2 patients leaving small asymptomatic residual lesions. Recurrences appeared in 3 patients with 2 of them having been surgically pretreated at the same location.

CONCLUSIONS

We recommend conservative treatment using protective padding as first line treatment for chondrodermatitis nodularis chronica helicis. The successful outcome achieved only by relief of pressure supports pressure as the main etiological factor in the development of the disease.

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

BACKGROUND

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.

OBJECTIVE

We sought to investigate possible nerve hyperplasia in CNCH.

METHODS

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.

RESULTS

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.

LIMITATIONS

Hypothesis based on morphologic observations.

CONCLUSIONS

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.