Continuous positive airway pressure device-associated nonhealing ulcer on the nasal dorsum: chondrodermatitis nodularis nasi

Pressure and Skin: A Review of Disease Entities Driven or Influenced by Mechanical Pressure

Skin perceives and reacts to external mechanical forces to create resistance against the external environment. Excessive or inappropriate stimuli of pressure may lead to cellular alterations of the skin and the development of both benign and malignant skin disorders. We conducted a comprehensive literature review to delve into the pressure-induced and aggravated skin disorders and their underlying pressure-related mechanisms. Dysregulated mechanical responses of the skin give rise to local inflammation, ischemia, necrosis, proliferation, hyperkeratosis, impaired regeneration, atrophy, or other injurious reactions, resulting in various disease entities. The use of personal devices, activities, occupations, weight bearing, and even unintentional object contact and postures are potential scenarios that account for the development of pressure-related skin disorders. The spectrum of these skin disorders may involve the epidermis (keratinocytes and melanocytes), hair follicles, eccrine glands, nail apparatuses, dermis (fibroblasts, mast cells, and vasculature), subcutis, and fascia. Clarifying the clinical context of each patient and recognizing how pressure at the cellular and tissue levels leads to skin lesions can enhance our comprehension of pressure-related skin disorders to attain better management.

New tender, bleeding papule on the left ear

Chondrodermatitis nodularis helicis (CNH) is a painful, inflammatory condition that impacts the skin of the ear. It is commonly associated with pressure on the pinna causing a nodule that may have erythema, bleeding and exudate. We present a case of a woman in her 60s with a history of basal cell carcinoma who presented with a new tender spot on the antihelix of her left ear. The tenderness of the new spot forced her to switch from holding her phone to her left ear to using her right ear. A shave biopsy confirmed CNH and ruled out non-melanoma skin cancer. Although most prior cases report association with sleeping on the side of the affected ear, this case was attributed to cell phone use. It is important to remember that non-traditional sources of pressure can also lead to CNH.