Chondrodermatitis nodularis helicis - Causes, Symptoms, Diagnosis, and Management

Introduction:

Chondrodermatitis nodularis helicis, also known as “Winkler's disease,” is a painful condition associated with skin and cartilaginous portions of the ears. This condition involves the helix (outer rim of the ear) of the pinna in most cases but also the antihelix (y-shaped curved part of the ear) in a few cases. It can affect one (unilateral) or both ears (bilateral). It is also known as ear pressure sores.

What Is the Prevalence of Chondrodermatitis Nodularis Helicis?

• The exact incidence of chondrodermatitis nodularis helicis is unknown, but it more frequently affects middle-aged and fair-skinned people.

• Males (70 to 90 percent) are more likely to have chondrodermatitis nodularis helicis than females (20 to 25 percent cases).

• It can affect one or both ears, but the right ear is affected more than the left ear.

What Are the Causes of Chondrodermatitis Nodularis Helicis?

The exact reason for chondrodermatitis nodularis helicis is not known. However, some reasons that are supposed to cause chondrodermatitis nodularis helicis are:

• Excessive pressure on the external ear.

• Sleeping consistently on the same side of the ears causes excess pressure and compromised blood supply in one ear frequently.

• Continuous use of headphones and earphones.

• Exposure to cold weather (frostbite) can act as a trigger factor.

• Connective tissue disorders like scleroderma (disease-causing hardening of the skin) or dermatomyositis (a disease with skin rash and muscle weakness).

• Trauma to the ear cartilage (leading to reduced blood supply in the region).

• Excessive exposure to the sun.

What Are the Signs and Symptoms of Chondrodermatitis Nodularis Helicis?

Signs and symptoms of chondrodermatitis nodularis helicis are:

• A small oval-shaped mass or nodule of 4 to 6 centimeters in diameter on the external ear gradually increases in size.

• Redness around the nodule.

• Pain and tenderness in the affected area.

• Pus discharge from the lesion.

• Bleeding from the lesion.

• Disturbance in sleep on the affected side at night due to pain.

• Swelling in the affected ears.

How to Diagnose Chondrodermatitis Nodularis Helicis?

Various diagnostic techniques for chondrodermatitis nodularis helicis are:

• History and Clinical Examination: A complete clinical history of the patient for the symptoms presented is recorded. Clinical examination is done by an ENT (ear, nose, and throat) specialist to check for the presence of a mass or nodule on the external ear surface, discharge from the affected area, and dry, scaly crust formation on the lesion.

• Biopsy: Excisional biopsy (cutting a tissue sample from the nodular mass) is recommended for the confirmatory diagnosis of the chondrodermatitis nodularis helicis. A biopsy tissue sample is sent to the lab for diagnosis. A biopsy helps to rule out any underlying connective tissue disorder like scleroderma (disease-causing hardening of the skin) or dermatomyositis (a disease with skin rash and muscle weakness) if present and also detects or differentiates between the presence of any skin malignancies (cancer) like basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and chondrodermatitis nodularis helicis.

What Are the Treatment Modalities for Chondrodermatitis Nodularis Helicis?

Various treatment modalities for chondrodermatitis nodularis helicis are:

Conservative Management:

• Pressure-Relieving Therapy: Pressure-relieving therapy aims to control excessive pressure on the affected area of the ears. Pressure-relieving prostheses (artificial devices) or pressure pads are advised for the patients, like doughnut pillows for use at night while sleeping, foam sponges, and foam bandages. It is one of the cost-effective methods to control the pressure on the lesion and manage the related symptoms.

Medicinal Therapy:

• Topical application of steroids on the affected area or intralesional (within the lesion or nodular mass) steroid injections like Triamcinolone acetonide can be given to the patient for reducing the swelling and size of the nodule.

• Topical (external) application of 2 percent of Nitroglycerin ointment on the affected area two times daily has proven to be effective in relieving the symptoms by increasing the blood supply in the affected area (vasodilation) and improving the appearance of the affected area by reducing the discoloration or redness present (reversing ischemic changes).

• Diltiazem cream application on the affected area also helps in relieving the symptoms.

• Fillers like collagen or hyaluronic acid injections under the skin above the cartilage of the affected area provide a cushion and insulating effect in the affected area.

Surgical Management:

• Punch Biopsy: It is done using a specialized instrument to remove the tissue in the affected area in a punch. A skin graft is placed on the affected area after the mass removal by punch biopsy.

• Curettage: It is another method to remove the affected tissues with the help of an instrument called a curette.

• Surgical Excision: Surgical removal of the lesion along with minimal surrounding normal tissue to prevent the risk of recurrence with the surgical blade is one of the methods to treat chondrodermatitis nodularis helicis.

• Electrocauterization: In this method, a probe tip-like instrument is used to cauterize (burn or vaporize) the lesions or nodules by the electric heat generated by the instrument.

• Laser Therapy: Carbon monoxide or argon lasers are used to remove the lesions in the affected area by the infrared light produced by them. It also creates a bloodless field with minimal scarring and is an alternative method to surgical excision by a blade.

• Cryotherapy: In this method, agents like liquid nitrous oxide remove the lesion or nodular mass by freezing the tissue with cryo tips (probe tip-like instruments).

How Can We Prevent Chondrodermatitis Nodularis Helicis?

• Avoid sleeping on the same side frequently.

• Avoid too much sun and cold by taking protective measures.

• Use a soft pillow.

• Apply vaseline to the affected area to keep it moist.

• Visit a doctor immediately in case of severe pain and aggravating symptoms.

Can Chondrodermatitis Nodularis Helicis Reoccur After the Treatment?

Yes, it can reoccur. The recurrence rate of chondrodermatitis nodularis helicis varies from 10 to 30 percent after the surgery.

Conclusion:

Chondrodermatitis nodularis helicis is a painful condition with a small nodular mass of 4 to 5 centimeters in size, gradually progressing to large lesions. It occurs due to excessive pressure on the ears due to trauma, frequently sleeping on one side, or due to the presence of underlying connective tissue disorders like scleroderma. Early diagnosis and management of the condition are crucial to treating the condition completely and preventing further progress. Although various treatment options like laser therapy, cryotherapy, and surgical management are available, there are certain chances of the condition recurring after the treatment.