Chondrodermatitis nodularis helicis hernia de disco lumbar ejercicios contraindicados

This is a relatively common condition that usually afflicts the rim of the auricle of the ear. Trauma and sun exposure have traditionally been cited as possible inciting agents. The histopathology is characteristic, showing necrobiotic changes within the collagen and eosinophilic degenerative changes within the underlying cartilage. There is recent evidence that suggests this condition may be a maker of internal syndromes associated with microvascular injury such as diabetes mellitus and connective tissue disorders.

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.

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.

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.

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.

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.

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.

Thirteen histologic specimens revealed transepidermal elimination (TE) of necrobiotic material from the dermis. This elimination occurred through transepidermal channels, slits, or erosions overlying a dermal necrobiotic granuloma. The granuloma was surrounded by granulation tissue composed of histiocytes and lymphocytes. Telangiectasia and peripheral solar elastosis were common findings.

Our study retrospectively reviews 21 additional cases. We conclude that idiopathic cystic chondromalacia can occur in both sexes, in all races, and at any age. The differential diagnoses for idiopathic cystic chondromalacia are relapsing polychondritis and chondrodermatitis nodularis chronica helicis.

RESULTS: Thirteen of the 15 patients (87%) treated nonsurgically were healed at follow-up after 1 month of conservative treatment and so have avoided surgery to date. In contrast, the recurrence rate of the surgically treated group was 14 of 41 (34%) patients.

Chondrodermatitis nodularis chronica helicis (CNCH) consists of a painful, erythematous, often crusted, papule most commonly found on the helical rim of the ear of white men over the age of 40 years old. It is seen less commonly in women and younger individuals, where the anatomic locations may vary to include the antihelix, antitragus, and other areas on the external ear. Over the years there have been many treatments for this disorder.

BACKGROUND: Chondrodermatitis nodularis (CN) is a common inflammatory condition of the ear that produces a painful papule or nodule on the helix or antihelix. Excision of the cartilage alone has been demonstrated to be therapeutically and cosmetically effective.

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear. In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease.

Reports on this technique claim excellent cosmetic results with only a small chance of recurrence. In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports. Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery.

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.