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Chrondrodermatitis Nodularis Helicas (CNH)

Chondrodermatitis helicis nodularis in a 67-year-old man. Photo credit: Klaus D. Peter, Gummersbach, Germany – Own work (own photograph), CC BY 3.0 de; Wikipedia Commons

 

The word dermatology derives from the 1) ___ dermatos and derma, meaning “skin.“ Originally it meant “to flay“ skin.

 

Chondrodermatitis nodularis chronica helicis (CNH), also known as chondrodermatitis nodularis helicis, is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the 2) ___. CNH is a common, benign, painful condition of the helix or antihelix of the ear which more often affects middle-aged or older men, but cases are also reported in women. In a 2006 report by Rex et al., of 74 patients treated for CNH, 72.9% of patients were 3) ___ while 16.2% were women.

 

Pediatric cases of CNH have also been reported, with one case reported in a 9-month-old infant. This case indicated that the infant slept on the ear of occurrence, where she developed 2 nodules. The infant had also recently started sleeping on a hard pillow, which may have contributed to the lesion. An excisional biopsy of the lesion at 9 months showed histologic features consistent with CNH. The papule resolved with a change in sleeping 4) ___ over 6 months.

 

The exact cause of CNH is unknown, although most experts believe it is caused by prolonged and excessive pressure. Several anatomic features of the ear predispose persons to the development of this condition. The ear has relatively little subcutaneous tissue for insulation and padding, and only small dermal blood 5) ___ supply the epidermis, dermis, perichondrium, and cartilage. Dermal inflammation, edema, and necrosis from trauma, cold, actinic damage, or pressure probably initiate the disease. In most cases, focal pressure on the stiff cartilage most likely produces damage to the cartilage and overlying skin. Anatomic features of the ear, as listed above, prevent adequate healing and lead to secondary perichondritis. The 6) ___ ear is more commonly involved. A 2009 report concluded that specific perichondrial arteriolar changes may be the cause of CNH. Although physicians have regarded CNH as an idiopathic disorder with no systemic associations, exceptions to this have been noted. CNH may also occasionally be associated with autoimmune or connective-tissue disorders, including autoimmune thyroiditis, lupus erythematosus, dermatomyositis, and scleroderma. Such cases may be more common in pediatric or young adult female patients. A 2009 report detailed CNH in monozygotic twins, suggesting a possible 7) ___ factor. The exact incidence of CNH is unknown. While the incidence in patients age 60-80 years is predominantly male, cases presenting in young 8) ___ appear to be associated with evidence of underlying systemic illness in some instances. CNH has been reported to occur most commonly in fair-skinned individuals with severely 9) ___-damaged skin; however, it can occur in persons of any races. The prognosis for patients with CNH is 10) ___, although long-term morbidity is common. Spontaneous resolution is the exception; remissions may occur, but CNH usually continues unless adequately treated.

 

ANSWERS: 1) Greek; 2) ear; 3) men; 4) position; 5) vessels; 6) right; 7) hereditary; 8) females; 9) sun; 10) excellent

 

Peter Wisch MD and his very sympatico nurse, Agata Tuszakowski, photo taken today at the end of my appointment. I thought I had a cancerous growth but the quick diagnosis was: Chondrodermatitis Nodularis Helicas. Dr. Wisch is the best dermatologist in New York, and has been our family’s dermatologist, for many years. His manner is kind, informative, reassuring and relaxing. We recommend Dr. Wisch highly for anyone looking for an excellent physician.

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