Chondrodermatitis nodularis chronica helicis

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Chondrodermatitis nodularis chronica helicis
Diagnosis in short

Synonyms chondrodermatitis nodularis helicis, Winkler disease

LM cartilaginous pathology (esp. perichondrial inflammation, perichondrial disruption +/-necrosis, +/-hemorrhage), overlying dermal inflammation, epithelial hyperlasia, (dermal) fibrosis
Gross papule on ear, +/-erythema, +/-crusting
Site ear by definition (skin)

Clinical history more often right ear
Signs tenderness
Symptoms pain
Prevalence uncommon
Prognosis benign
Clin. DDx BCC, SCC

Chondrodermatitis nodularis chronica helicis, abbreviated CNCH, is an uncommon painful condition that afflicts the ear.

It is also known as chondrodermatitis nodularis helicis and Winkler disease.[1]

General

  • Tender/painful - key clinical feature.
  • Typically right ear - people more often sleep on this one.[2]
  • Usually >40 years old.

Etiology:

  • Trauma/mechanical.

Gross

  • Papule on ear.
  • +/-Erythematous.
  • +/-Crust.

Clinical DDx:[2]

Images

www:

Microscopic

Features:[2]

  • Dermal inflammation.
  • Epithelial hyperlasia.
  • Fibrosis.
  • Cartilaginous pathology:
    • Perichondrial inflammation - key feature.
    • Perichondrial disruption.
    • +/-Necrosis.
    • +/-Hemorrhage.

Images

Sign out

Skin Lesion, Right Ear, Excision:
- Compatible with chondrodermatitis nodularis chronica helicis.

Micro

The sections show skin with epidermal hyperplasia, parakeratosis and a thickened granular cell layer. The subepithelial tissue has a scattered perivascular lymphocyte predominant inflammatory infiltrate that extends to the cartilage. The cartilage shows focal ischemic changes and perichondral inflammation. Focal chondral necrosis and microabscess formation is identified. Maturing granulation tissue is seen adjacent to the cartilage.

Superficial biopsy

SKIN LESION, LEFT ANTIHELIX OF EAR, BIOPSY:
- SUPERFICIAL SKIN WITH ACANTHOSIS, HYPERKERATOSIS, MODERATE SOLAR ELASTOSIS, 
  HYPERGRANULOSIS AND A MILD LYMPHOCYTIC PERIVASCULAR INFILTRATE.
- NO CARTILAGE IS IDENTIFIED.
- NEGATIVE FOR DYSPLASIA AND MALIGNANCY.

COMMENT:
The findings are non-specific. Chondrodermatitis cannot be excluded.

See also

References

  1. URL: http://www.head-face-med.com/content/4/1/2. Accessed on: 16 January 2014.
  2. 2.0 2.1 2.2 Devani, A.; Barankin, B. (May 2007). "Dermacase. Chondrodermatitis nodularis chronica helicis.". Can Fam Physician 53 (5): 821, 837. PMID 17879469.