Topical nitroglycerin: A promising treatment option for chondrodermatitis nodularis helicis

doi:10.1016/j.jaad.2010.06.012

Journal of the American Academy of Dermatology

Volume 65, Issue 3, September 2011, Pages 531-536

https://doi.org/10.1016/j.jaad.2010.06.012 Get rights and content

Background

Chondrodermatitis nodularis helicis (CNH) is a painful nodule that often interferes with sleep and occurs on the helix or antihelix of the ear in older patients. Although several case reports describe a variety of seemingly effective surgical and conservative treatment options, well-studied treatment modalities have varying efficacy rates and can often demonstrate disappointing results.

Objectives

The purpose of this study was to evaluate the efficacy of 2% topical nitroglycerin for the treatment of CNH.

Methods

A retrospective chart review was performed in 12 patients given the diagnosis of CNH who received 2% topical nitroglycerin twice daily for therapy. Therapeutic efficacy was determined by identifying improvement in the appearance and symptomatology of the lesion.

Results

A total of 13 lesions in 12 patients were treated, with 12 (92%) lesions demonstrating improvement with the use of topical nitroglycerin. Eight of 13 (61.5%) CNH lesions developed complete clearance and resolution of symptoms, requiring no further treatment. Four of 13 (30.8%) lesions were found to have only symptomatic improvement, and these patients continued to use the ointment as needed. One of 12 (8.3%) patients found no benefit with the treatment but had also failed multiple other treatments modalities.

Limitations

Limitations include the small number of patients treated and the retrospective nature of the study.

Conclusions

Topical nitroglycerin demonstrated efficacy in treating both the symptoms and lesional appearance of CNH in a noninvasive manner, with an overall success rate that is comparable with other published methods.

Section snippets

Methods

Upon receiving permission from the institutional review board, we performed a chart review identifying patients who were prescribed topical nitroglycerin specifically for the treatment of CNH. We evaluated the patient history and physical examination (from initial and follow-up visits) for the appearance, associated symptoms and duration of the lesion, type(s) and dosage of treatment used, duration of therapy, medication side effects, and efficacy of treatment. Therapeutic efficacy is

Results

A total of 15 patients were identified who were given the diagnosis of CNH and subsequently treated with topical nitroglycerin at our department of dermatology. Time of diagnosis and treatment periods ranged from September 2007 through November 2009. Two patients were lost to follow-up and one patient treated had no mention of therapeutic results at their returning visit. Thus, a total of 13 lesions in 12 patients were reviewed for analysis.

Patient age ranges were from 61 to 91 years, with a

Discussion

CNH has been recently postulated as the end result of pinna dermal and chondral ischemia arising from perichondrial arteriolar narrowing.¹³ Tissue ischemia leads to necrosis of the cartilage with subsequent expulsion via necrobiosis and ulceration of the overlying dermis or transepidermal elimination. Nitroglycerin is known to cause smooth muscle relaxation and vasodilation. It has also been reported to be effective in treating Raynaud phenomenon, another manifestation of aberrant vascular

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Cited by (19)

Usefulness of 2% Topical Diltiazem in Chondrodermatitis Nodularis Helicis: A Report of 2 Cases
2019, Actas Dermo-Sifiliograficas
Topical nitroglycerin in chondrodermatitis nodularis helicis
2018, Piel
Diagnostic Pathology: Head & Neck
2017, Diagnostic Pathology: Head and Neck
The utility of full-thickness skin grafts (FTSGs) for auricular reconstruction
2016, Journal of the American Academy of Dermatology
Citation Excerpt :
Postoperative pain, commonly a result of perichondritis, is most responsive to nonsteroidal anti-inflammatory medications or topical nitroglycerin ointment. The latter has been shown to be effective in the setting of chondrodermatitis nodularis helicis,23 and we have found it to be a useful option for pain management of nonsuppurative perichondritis. Similar to the dosing used for chondrodermatitis nodularis helicis, patients are instructed to apply 2% topical nitroglycerin to the wound site twice daily.
Full-thickness skin grafts (FTSGs) are a common repair option on the external ear, but there are few large case series examining graft sublocations, dimensions, and outcomes.
We sought to report our experience with FTSGs for repair of postsurgical defects of the external ear.
We conducted a retrospective review of all FTSGs on the ear performed by 2 surgeons (J. C., 2000-2014; B. C. L., 2007-2014) after clearance by Mohs micrographic surgery at a single institution.
A total of 1519 FTSGs on the ear were performed between June 2000 and March 2014. The most common sublocations were the superior helix (38.8%), the crura of the antihelix or scapha (18.9%), and the back of ear/back of helix (15.4%). The overall complication rate was 1.6%, and the most common complication was graft failure (1.2%).
Data were collected retrospectively from a single institution. Follow-up beyond 3 months was limited. A standardized assessment tool for aesthetic outcomes was not performed.
By taking advantage of predictable “pincushioning” and combining with local flaps or cartilage grafts, FTSGs can provide more volumetric replacement than previously described. They reliably preserve the height and complex topography of the ear with a low complication rate.
The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis
2015, Actas Dermo-Sifiliograficas
Citation Excerpt :
In any case, involvement of the vascular network of the auricle, whether as a cause or consequence of local connective tissue degeneration, could account for the satisfactory results achieved treating CNH with topical nitroglycerin, which is a potent vasodilator. The first report of the efficacy of topical nitroglycerin in CNH was by Flynn et al.,5 who treated 13 patients with 2% topical nitroglycerin. A clinical improvement was recorded in 12 patients.
Chondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH.
We performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale.
Of the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases.
Topical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.
La condrodermatitis nodular del hélix (CNH) es un proceso idiopático, degenerativo y doloroso que afecta a la piel y al cartílago del hélix o del antéhelix.
Recientemente se ha descrito la utilidad de la nitroglicerina (NTG) tópica a 2% en el tratamiento de la CNH con buenos resultados, aunque con una tasa de efectos secundarios en el 17% de los casos. Es probable que a una concentración menor se pueda mantener el mismo efecto mejorando la tolerancia.
Nuestra finalidad fue evaluar la efectividad y seguridad de la NTG tópica al 0,2% para el tratamiento de la CNH.
Se llevó a cabo un estudio observacional retrospectivo entre los años 2012 y 2014 en 2 centros hospitalarios españoles. La efectividad se determinó a través de la evaluación clínica, realizada mediante seguimiento fotográfico, y de los síntomas de la lesión, medido mediante una escala numérica verbal.
Veintinueve pacientes recibieron el tratamiento, de los cuales el 93% manifestaron una mejoría clínica con una duración media del tratamiento de 1,8 meses y un tiempo de seguimiento medio en los pacientes respondedores de 5,9 meses. La tolerancia fue buena en general en todos los casos.
La NTG tópica al 0,2% se plantea como una opción conservadora, efectiva y bien tolerada para el tratamiento de la condrodermatitis nodular del hélix que mejora tanto la apariencia clínica como la sintomatología en la mayoría de los pacientes.
Chondrodermatitis nodularis helicis: Successful treatment with 2% nitroglycerin gel
2013, Actas Dermo-Sifiliograficas

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: Conflicts of interest: None declared.

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Original articleTopical nitroglycerin: A promising treatment option for chondrodermatitis nodularis helicis

Background

Objectives

Methods

Results

Limitations

Conclusions

Section snippets

Methods

Results

Discussion

J Am Acad Dermatol

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Gastroenterology

Chondrodermatitis nodularis chronica helicis in monozygotic twins

Clin Exp Dermatol

Chondrodermatitis nodularis chronica helicis

Ear Nose Throat J

Chondrodermatitis nodularis helicis

Ear Nose Throat J

The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis

Br J Dermatol

Management of chondrodermatitis nodularis chronica helicis using a “doughnut pillow”

J Laryngol Otol

The treatment of chondrodermatitis nodularis chronica helicis with local injections of triamcinolone acetonide

Aust J Dermatol

The treatment of chondrodermatitis nodularis chronica helicis with injectable collagen

Pharmacol Ther

Chondrodermatitis nodularis chronica helicis: successful treatment with the carbon dioxide laser

J Dermatol Surg Oncol

Original article
Topical nitroglycerin: A promising treatment option for chondrodermatitis nodularis helicis