Chondrodermatitis nodularis helicis in the 21st century: demographic trends from a gender and age perspective. A single University hospital retrospective histopathological register study of 215 patients in Asturias, North Spain (2000–2017)

Abstract

Dear Editor, Chondrodermatitis nodularis helicis (CNH) is an exceptionally investigated disease. 1 Male sex and old age characterize its demographic profile, 1-3 but this has not been recently investigated. With this aim, we performed this descriptive, retrospective, observational investigation including 215 patients histopathologically diagnosed of CNH at Central University Hospital of Asturias, northern Spain, (years 2000-2017). It was approved by the Hospital's ethics committee. Univariate analyses were conducted by chi-squared test and Fisher's test. A two-sided P value of 0.05 was considered statistically significant (R program, The R Foundation, Indianapolis, IN, USA; R Development Core Team, version 3.6.0).The mean age of patients was 68.1 years (women, 71.7; men, 66.2 years; range 24-95 years). Most patients (72%) had more than 60 years at diagnosis and most (65%) were men. This male excess significantly decreased with age (P < 0.01; Table 1). Women became 51.3% after 80 years at diagnosis (male/female Ratio: 0.9).A 56% increase in the CNH diagnosis number was observed during the periods (2000-2008 vs. 2009-2017 years; Table 2). This was greater in women (216.7%) than in men (12%); and evidenced only in the late-onset subgroup (+98%). The most remarkable increase in number was in women over 60 years at diagnosis (277%).As previous but much smaller studies, 1,2 the mean age at diagnosis was 68 years old (published range varies from 40 to 70 years). 2 71% of patients had CNH diagnosis after 60 years. CNH was diagnosed later in women. Children or adolescent were absent supporting the rarity of CNH at this age 4 . We found a 65% male predominance. Nielsen et al. 1 found 60% of males in a PubMed review of 27 studies (including 628 males and 452 females). Wettle et al. 2 reported published variations of the male/female ratio ranging from 1 to 7.6; and early studies reported males outnumbered females by 10 to 1. 5 Female predominance was rarely described. 6,7 We remark that we described for the first time that male excess was age-dependent, (P < 0.01) and reversed after 80 years at diagnosis. Age differences in Ratio Male/Female 3.6 1.3 Decrease

Possible association of early - onset chondrodermatitis nodularis and risk of mortality. Results of a pilot retrospective case-control single-hospital study in Asturias, Northen Spain.

“…CN is triggered by external microtrauma [4], cold exposure, damage from contact with cell phone [8] and, rarely, surgery. Changes related to ageing and chronic actinic damage favour its development [ [4,5,7,12,16]: most patients with CN (70%) have more than 60 years at diagnosis and most patients are men (65%) [14].…”

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“…Über den untersuchten Zeitraum gab es eine deutliche Zunahme der Gesamtzahl der Diagnosen, mit einem besonders starken Anstieg bei älteren Frauen. Mögliche Ursachen für diese Zunahme könnten eine steigende Handynutzung, erhöhte Lebenserwartung und vermehrte Sonnenexposition sein [9].…”

Premature chondrodermatitis nodularis (<61 years): Another acquired perforating dermatosis with a potential association with diabetes mellitus in a two‐centre, case‐control, retrospective, 22‐year study

“…CN is a painful form of APD that is rare before the age of 60 years (30%) and in females (35%). 3 CN is mainly triggered by trauma, and favored by age, chronic sun damage, and tobacco smoking. 4,5 In addition, we report for the first time that an association with DM could also be possible in adult patients with a premature diagnosis of CN (<61 years).…”