Chondrodermatitis Nodularis Chronica Helicis

Chondrodermatitis nodularis chronica helicis (CNH) is a skin condition that affects the cartilage of the ear. It is a painful, benign growth that typically occurs on the outer edge of the ear, known as the helix. In this article, we will discuss the different types of CNH, their symptoms, causes, and treatments.

Types

Types of Chondrodermatitis nodularis chronica helicis

There are two main types of CNH: primary and secondary. Let’s take a closer look at each of them.

1. Primary CNH

Primary CNH is also known as idiopathic CNH because the exact cause is unknown. It typically affects middle-aged or older individuals and is more common in men than women. This type of CNH usually develops on only one ear and presents as a small, tender, red, and sometimes crusty lump on the helix. The lump can grow over time and become more painful, making it difficult to sleep on the affected side. Primary CNH is often associated with pressure and friction on the ear, which can be caused by wearing tight hats, sleeping on one side, or using headphones.

2. Secondary CNH

Secondary CNH is caused by an underlying condition or trauma. This type of CNH can occur on one or both ears and can develop at any age. The lump is often larger than the one seen in primary CNH and may have a yellow or white center. The lump may also be accompanied by other symptoms, such as pain, tenderness, and itching. The underlying causes of secondary CNH can include trauma to the ear, such as a blow or injury, and autoimmune disorders such as lupus or rheumatoid arthritis.

Causes

Causes of CNCH in detail.

1. Trauma: Trauma or injury to the ear is a leading cause of CNCH. This can be due to repetitive pressure or friction on the ear, such as from sleeping on one’s side, wearing tight-fitting headphones or headsets, or using a telephone for long periods.
2. Sun exposure: Prolonged exposure to the sun’s harmful UV rays can damage the skin and cartilage of the ear, leading to CNCH.
3. Cold temperatures: Exposure to cold temperatures can also cause CNCH, as it can lead to decreased blood flow and tissue damage.
4. Genetics: There is some evidence to suggest that CNCH may be inherited, although more research is needed to confirm this.
5. Age: CNCH is more common in older adults, especially those over 50 years of age.
6. Gender: CNCH is more common in men than women, although the reason for this is not fully understood.
7. Smoking: Smoking has been linked to a higher risk of CNCH, likely due to the harmful chemicals in cigarettes that can damage the skin and cartilage of the ear.
8. Medical conditions: Certain medical conditions, such as diabetes and autoimmune diseases, have been linked to an increased risk of CNCH.
9. Medications: Some medications, such as chemotherapy drugs and immunosuppressants, have been associated with the development of CNCH.
10. Occupational hazards: Certain occupations, such as those that involve exposure to chemicals or prolonged pressure on the ear, may increase the risk of CNCH.
11. Poor sleep quality: Poor sleep quality, particularly if one consistently sleeps on one’s side, can increase the risk of CNCH.
12. Poor nutrition: A diet that is low in nutrients, particularly vitamin A and zinc, can weaken the immune system and make the skin and cartilage of the ear more vulnerable to CNCH.
13. Hormonal imbalances: Hormonal imbalances, such as those that occur during pregnancy or menopause, may increase the risk of CNCH.
14. Infections: In rare cases, CNCH may be caused by a bacterial or viral infection of the ear.
15. Allergies: Allergies to certain foods or environmental allergens may increase the risk of CNCH.
16. Poor hygiene: Poor hygiene, such as not regularly cleaning the ears or using dirty earbuds or headphones, can increase the risk of CNCH.
17. Poor blood circulation: Poor blood circulation to the ear, due to conditions such as Raynaud’s disease, can increase the risk of CNCH.
18. Chronic inflammation: Chronic inflammation in the body, such as that caused by autoimmune diseases or chronic infections, may increase the risk of CNCH.
19. Pressure on the ear: Pressure on the ear, such as from wearing tight-fitting hats or headbands, can increase the risk of CNCH.
20. Skin conditions: Certain skin conditions, such as eczema or psoriasis, may increase the risk of CNCH.

Symptoms

Symptoms of CNCH and their details.

1. Pain: Pain is the most common symptom of CNCH. It is usually described as a sharp or throbbing pain that is localized to the affected area.
2. Tender to touch: The nodule may be tender to touch and may be aggravated by pressure or friction.
3. Redness: The skin over the nodule may be reddened.
4. Swelling: The nodule may be accompanied by swelling of the surrounding tissue.
5. Itching: Some patients may experience itching around the affected area.
6. Crusting: The nodule may become crusted over time.
7. Bleeding: The nodule may bleed if it is scratched or injured.
8. Ulceration: In severe cases, the nodule may ulcerate and become an open sore.
9. Discharge: Some patients may experience discharge from the affected area.
10. Scabbing: The nodule may form a scab as it heals.
11. Flaking: The skin around the nodule may become flaky or dry.
12. Numbness: Rarely, some patients may experience numbness around the affected area.
13. Burning sensation: Some patients may experience a burning sensation around the affected area.
14. Difficulty sleeping: The pain and discomfort associated with CNCH may make it difficult to sleep.
15. Fatigue: The pain and discomfort associated with CNCH may lead to fatigue.
16. Irritability: The pain and discomfort associated with CNCH may lead to irritability.
17. Depression: In some cases, CNCH may lead to depression due to the chronic nature of the condition.
18. Anxiety: The pain and discomfort associated with CNCH may lead to anxiety.
19. Headaches: Some patients may experience headaches as a result of the pain associated with CNCH.
20. Jaw pain: In rare cases, CNCH may cause pain in the jaw.

Diagnosis

Common diagnoses and tests for CNH, as well as their details.

1. Physical examination: A physical examination is the first step in diagnosing CNH. During the examination, a healthcare professional will inspect the ear for signs of inflammation, redness, and bumps.
2. Skin biopsy: A skin biopsy involves taking a small sample of skin tissue from the affected area. This tissue is then examined under a microscope to look for any abnormalities that may indicate CNH.
3. Dermoscopy: Dermoscopy is a non-invasive imaging technique that allows healthcare professionals to examine the skin in greater detail. It can be helpful in identifying the characteristic features of CNH.
4. Blood tests: Blood tests may be performed to rule out other conditions that can cause similar symptoms, such as rheumatoid arthritis.
5. X-rays: X-rays may be taken to rule out other underlying conditions, such as osteoarthritis, that may be causing CNH.
6. MRI: An MRI can be helpful in identifying any structural abnormalities in the ear that may be contributing to CNH.
7. CT scan: A CT scan is another imaging technique that can be used to identify any structural abnormalities in the ear.
8. Ultrasound: An ultrasound can be used to evaluate the blood flow to the ear and identify any abnormalities that may be causing CNH.
9. Skin culture: A skin culture involves taking a sample of the skin from the affected area and growing it in a laboratory. This can help to identify any bacterial or fungal infections that may be contributing to CNH.
10. Patch testing: Patch testing involves applying small amounts of different substances to the skin to see if an allergic reaction occurs. This can be helpful in identifying any allergies that may be causing CNH.
11. Allergy testing: Allergy testing involves testing for specific allergens that may be causing CNH. This can be done through blood tests or skin prick tests.
12. Biopsy for histopathology: A biopsy for histopathology involves taking a small sample of tissue from the affected area and examining it under a microscope to look for any abnormalities.
13. Needle aspiration: Needle aspiration involves using a needle to remove fluid from the affected area. This can be helpful in relieving pain and reducing inflammation.
14. Electromyography (EMG): EMG is a test that measures the electrical activity in muscles. It can be helpful in identifying any nerve damage that may be contributing to CNH.
15. Nerve conduction studies: Nerve conduction studies measure how quickly nerve signals travel through the body. They can be helpful in identifying any nerve damage that may be contributing to CNH.
16. Audiometry: Audiometry is a test that measures hearing ability. It can be helpful in identifying any hearing loss that may be associated with CNH.
17. Tympanometry: Tympanometry measures the movement of the eardrum in response to changes in air pressure. It can be helpful in identifying any abnormalities in the middle ear that may be contributing to CNH.
18. Vestibular testing: Vestibular testing measures the function of the vestibular system, which is responsible for balance and spatial orientation. It can be helpful in identifying any vestibular abnormalities that may be associated with CNH.
19. Electrocochleography (ECochG): ECochG is a test that measures the electrical activity in the inner ear. It can be helpful

Treatment

Treatments for CNCH, explained in detail.

1. Topical steroids: Topical steroids are a common treatment for CNCH. They work by reducing inflammation and itching, which can help relieve pain and discomfort. These medications can be applied directly to the affected area and come in a variety of strengths.
2. Topical calcineurin inhibitors: Another type of topical medication that can be used to treat CNCH are calcineurin inhibitors, such as tacrolimus and pimecrolimus. These medications work by suppressing the immune system and reducing inflammation.
3. Cryotherapy: Cryotherapy involves using extreme cold to freeze and destroy abnormal tissue. This treatment can be effective for CNCH, as it can help reduce inflammation and pain.
4. Curettage: Curettage involves scraping away the affected tissue using a sharp instrument. While it can be painful, it can also be effective for removing CNCH bumps.
5. Electrocautery: Electrocautery involves using an electric current to burn away the affected tissue. This treatment can be effective for removing CNCH bumps, but can also be painful.
6. Laser therapy: Laser therapy involves using a high-energy laser to destroy the affected tissue. While it can be effective, it can also be expensive and may require multiple treatments.
7. Photodynamic therapy: Photodynamic therapy involves applying a light-sensitive medication to the affected area and then using a special light to activate it. This treatment can be effective for CNCH, but can also be expensive and may require multiple treatments.
8. Intralesional steroids: Intralesional steroids involve injecting a steroid medication directly into the affected tissue. This treatment can be effective for reducing inflammation and pain.
9. Antibiotics: Antibiotics may be prescribed if the CNCH is infected. These medications can help clear up the infection and prevent it from spreading.
10. Antifungal medications: If the CNCH is caused by a fungal infection, antifungal medications may be prescribed. These medications can help clear up the infection and prevent it from spreading.
11. Pain relievers: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help relieve the pain associated with CNCH.
12. Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin or naproxen can help reduce inflammation and relieve pain.
13. Capsaicin cream: Capsaicin cream is derived from chili peppers and can be applied topically to the affected area. It works by reducing pain signals in the nerves.
14. Lidocaine patches: Lidocaine patches are applied directly to the affected area and work by numbing the nerves, which can help reduce pain.
15. Compresses: Applying warm or cold compresses to the affected area can help reduce inflammation and relieve pain.
16. Silicone gel sheets: Silicone gel sheets can be placed over the affected area to help reduce friction and pressure, which can aggravate CNCH.
17. Avoiding pressure: Avoiding pressure on the affected area, such as sleeping on the opposite side or using a soft pillow, can help reduce pain and prevent further damage.
18. Sun protection: Protecting the affected area from the sun can help prevent further damage and reduce the risk of skin cancer.

References