Topical nitroglycerin in the management of chondrodermatitis nodularis helicis: A comprehensive review

Introduction. Chondrodermatitis nodularis helicis (CNH) is a benign but painful inflammatory nodule of the helix or antihelix that mainly affects older adults and often disturbs sleep. It is widely regarded as the result of chronic pressure and ischemia of the relatively avascular ear cartilage, which is the rationale for treatments that improve local perfusion. Topical nitroglycerin (glyceryl trinitrate), a vasodilator, has been proposed as a non-invasive, low-cost option. Aim of the study. To analyze the evidence on the efficacy and tolerability of topical nitroglycerin for CNH, including the influence of concentration and formulation and its place among other treatments. Material and method. This comprehensive narrative review searched PubMed (supplemented by reference-list screening) using the terms “chondrodermatitis nodularis helicis,” “nitroglycerin,” and “glyceryl trinitrate.” English-language clinical reports of topical nitroglycerin for CNH and relevant background literature were reviewed and summarized descriptively. Results. Across case reports and small prospective and retrospective series, topical nitroglycerin (0.2–2%, as ointment, gel, or patch) produced clinical improvement in about 90% of treated lesions with mainly transient headache that was readily managed by dose reduction or dilution. Although surgery retains the highest strict cure rate among modalities with substantial evidence, nitroglycerin offers substantial symptomatic and lesional benefit without the cost or morbidity of an operation and is a reasonable first choice among conservative measures. Larger controlled trials are warranted to confirm these findings.