Neural hyperplasia in chondrodermatitis nodularis chronica helicis.
2006 Nov;55(5):844-8.
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.
Chondrodermatitis
nodularis helicis as a marker of internal syndromes associated with
microvascular injury.
J Cutan Pathol.
2005;32(5):329-33.
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.
Juvenile
chondrodermatitis nodularis helicis: a case report and literature
review.Pediatr
Dermatol. 2003 Nov-Dec;20(6):488-90.
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.
Chondrodermatitis nodularis chronica helicis.
Arch Fam Med.1999 Sep-Oct; 8(5):445-7.
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.
Chondrodermatitis nodularis chronica helicis et antihelicis.
Br J Plast Surg. 1996 Oct;49(7):473-6.
A retrospective
study of 50 patients (25 male, 25 female) suffering from
chondrodermatitis nodularis chronica is presented. There was equal
distribution between male and female, with the nodule being situated
on the helix in 36 cases (23 male, 13 female), and on the antihelix in
18 cases (4 male, 14 female).
Four patients had bilateral lesions. All the patients complained of
severe pain in the affected ear when they slept on it at night. Of the
54 ears in this study, 23 had undergone previous surgery for the
complaint. These recurrences occurred when either skin alone, or a
disproportionately large piece of skin relative to cartilage, was
excised.
A treatment technique is described involving minimal skin excision
combined with extensive cartilage resection. There has been no
recurrence following our technique and postoperative deformity has
been minimal.
Chondrodermatitis nodularis helicis occurring with systemic
sclerosis--an under-reported association?
Clin Exp Dermatol. 1994 May;19(3):219-20.
Three cases of
chondrodermatitis nodularis helicis (CDNH) in patients with the
limited form of systemic sclerosis are described.
Two of the three cases were noted during regular follow-up visits and
the third case was found as part of a survey of the 21 other patients
with systemic sclerosis routinely seen in the department.
While CDNH is known to have several predisposing causes there are no
reports in the literature of this condition occurring in association
with systemic sclerosis.
The
surgical management of chondrodermatitis nodularis chronica helicis.
J Dermatol Surg Oncol. 1991
Nov;17(11):902-4.
Surgical
management of chondrodermatitis nodularis chronica helicis by
curettage is described. The curet directs the dissection.
The necrotic cartilage is soft and is removed easily. The endpoint is
reached when the curet is repelled by firm, elastic cartilage.
Contours remain normal because the skin is tented over the defect
supported by the remaining cartilage.
Chondrodermatitis nodularis chronica helicis treated with curettage
and electro-cauterization: follow-up of a 15-year material.
Acta Derm Venereol. 1983;63(1):85-7.
During the
15-year period from 1965 to 1979 a total of 142 cases of
chondrodermatitis nodularis chronica helicis were diagnosed. 32% were
women, a higher proportion than in earlier materials.
The treatment was principally curettage followed by
electrocauterization. 78 patients were re-examined after an average
lag of 7.1 years. The relapse rate was 31%.
This simple surgical technique seems equal to the more elaborate
procedures in respect of recurrence rate and more satisfactory from a
cosmetic point of view.
Chondrodermatitis nodularis helicis: a
transepidermal perforating disorder.J
Cutan Pathol. 1980 Apr;7(2):70-6.
Chondrodermatitis nodularis helicis is a chronic disorder occurring
exclusively on the ear. It is most common in the sixth decade, and two
thirds of the patients are men.
Although it has no single characteristic histologic feature, a
diagnosis can be made with certainty with a clinical history and a
combination of morphologic changes seen in the cartilage and overlying
skin.
The natural history and histology are similar to a group of disorders
characterized by transepithelial elimination known as the perforating
dermatoses.
Chondrodermatitis helicis: a clinical
re-evaluation and pathological review.
Laryngoscope. 1976 Sep;86(9):1402-12.
Chondrodermatitis helicis, or painful nodule of the ear, is an
uncommon benign aural lesion which is seen and treated by
dermatologists and otolaryngologists. Because of the sparcity of
reports in the recent literature, our experience with 50 patients over
a 10-year period is presented.
The diagnosis is based on history and physical examination and biopsy
need be performed only to confirm the diagnosis in atypical cases.
Patients are generally middle-aged or elderly males. There are no
associated systemic disorders with this condition. The lesions are
discrete, grey to red in color, oval shaped with raised rolled edges,
and a central ulcer or depression which often contains a crust or
scale. The lesion is typically painful and tender and, for this
reason, the patient seeks help shortly after the onset of symptoms.
The characteristic histopathologic features are epithelial
hyperplasia, collagen degeneration, focal fibrinoid necrosis, and
inflammatory components.
Clinically, the lesion is misdiagnosed in the majority of instances
and is presumably, therefore, treated inappropriately. It should be
stressed that this is a benign condition and initial management should
be aimed at conservative therapy with local steroid injection or
conservative non-deforming surgery.
Wide excision, including removal of the underlying cartilage with
appropriate reconstrictive closure should be reserved for the
conservative treatment failures.
|
