Letters to the Editor

Chondrodermatitis nodularis helicis

Li-wen Zhang, MD, Juan Wu, MD, PhD and Tao Chen, MD, PhD
Cleveland Clinic Journal of Medicine June 2023, 90 (6) 333; DOI: https://doi.org/10.3949/ccjm.90c.06001

To the Editor: In the May issue, Maggie So and Randall Edson1 reported on an older man with a central crust over an ulcerated nodule on the left ear, diagnosed as chondrodermatitis nodularis helicis (CNH) based on the clinical findings. We have two suggestions for the diagnosis and management of CNH.

First, auricular granuloma annulare (AGA) should be considered in the differential diagnosis because it has a clinical presentation and location similar to CNH. AGA commonly presents as multiple, asymptomatic, unbroken nodules on unilateral or bilateral ears, although occasionally a solitary crusted nodule with mild tenderness may be present.2 The main difference is that the pathological features of AGA show dermal collagen degeneration, mucin deposition, and either a palisaded or interstitial histiocytic infiltrate. Typical pathological findings include a nodule of degenerated homogeneous collagen surrounded by vascular granulation tissue with an overlying acanthotic epidermis, a central ulcer, inflammation and fibrosis of the underlying perichondrium, and degenerative cartilage.

Another concern is that some patients with CNH may have other associated chronic inflammatory and autoimmune diseases, such as polymyalgia rheumatica, psoriasis, rheumatoid arthritis, CREST syndrome, vitiligo, and chronic dermatitis.3 Therefore, careful history-taking, physical examination, and some targeted laboratory tests are still necessary for the patient with CNH.

REFERENCES

    1. So M,
    2. Edson RS
    . Chondrodermatitis nodularis helicis. Cleve Clin J Med 2023; 90(5):277–278. doi:10.3949/ccjm.90a.22078
    1. Zhang LW,
    2. Jiang CH,
    3. Wang WJ,
    4. He L,
    5. Chen T
    . Auricular granuloma annulare. Indian J Dermatol Venereol Leprol 2022; 88(6):800–803. doi:10.25259/IJDVL_197_2021
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    5. Galache Osuna C
    . Spectrum of comorbid autoimmune diseases in patients with chondrodermatitis nodularis helicis: a 17-year retrospective study of 215 patients in Asturias, northern Spain. Eur J Dermatol 2022; 32(3):347–351. doi:10.1684/ejd.2022.4273