What is it?

Rhinophyma is the slow thickening of the nasal skin. It affects adults and is more common in men than in women.

What causes it?

The cause of rhinophyma is unknown but it is linked to rosacea.

What does it look like?

The nasal skin slowly thickens and develops nodules (lumps), eventually causing a larger, bulbous, misshapen looking nose. The oil glands are enlarged and the pores are more prominent.

Image reproduced with permission of Department of Dermatology St Vincent’s Hospital Melbourne

The majority of people with rhinophyma also have inflammatory rosacea, with acne-like lumps and bumps and sometimes pustules affecting the central face. The nose and surrounding skin are frequently red with an increased numbers of blood vessels.

What other problems can occur with this condition?

Rhinophyma is associated with rosacea.  It is important to recognise that rhinophyma is not linked to alcohol intake, though in the mind of the general public, it has been blamed as a cause.

How is it diagnosed?

There are no special investigations for this condition. It is diagnosed by physical examination of the skin.

How is it treated?

Management of rhinophyma is twofold: firstly, management of the underlying rosacea and secondly, treatment directed towards the thickened nasal skin.

Typically, people with rosacea and rhinophyma will require oral medication to reduce the inflammation. The most commonly used medications are tetracycline antibiotics (doxycycline, minocycline).  A low dosage of isotretinoin can also be effective in shrinking enlarged oil glands.

The mainstay of treatment however is some type of surgical removal of the thickened and redundant skin.  This can be achieved with a variety of devices. Ablative laser such as carbon dioxide and erbium lasers are commonly used.  Other devices include the use of electrical currents (diathermy) to remove tissue.  Such treatment creates a raw wound which will heal over 2 to 3 weeks to leave an improved appearance.  Treatment of the blood vessels can be targeted by laser and light systems.

This person was treated with a combination of surgery and CO2 laser.
Images reproduced with permission of Dr Davin Lim

What is the likely outcome of this condition?

Rhinophyma will progress without adequate treatment. A combination of both medical and surgical management provides excellent results.

This information has been written by Dr Shawn Richards


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