Rhinophyma is a progressive skin condition that sometimes affects those with rosacea. When rosacea develops, sometimes the nose becomes swollen and red, gaining a bumpy surface that changes the nose's shape. The swelling is known as rhinophyma which can appear as the formation of scar-like tissue that may increase over time.
Sometimes, rhinophyma can appear on other parts of the face such as the ears and chin, though this is rarer. Rhinophyma usually only develops in those who have rosacea which has been active and untreated for many years. Rhinophyma mainly affects fair-skinned men aged 50 to 70 years.
What is rhinophyma? rhinophyma is a skin disorder characterized by a large, red, bumpy or bulbous nose. It can occur as part of phymatous rosacea. The exact cause of rhinophyma is unknown, but it’s considered a subtype of severe rosacea. This condition is significantly more common in men, especially between the ages of 50 to 70 years. Overall, rosacea is a common, chronic inflammatory skin condition. It causes irregular redness or flushing of your face, particularly in the cheeks or nasal areas. Small, red bumps filled with pus, called pustules, may appear on your face as part of this condition.
How is the severity of rhinophyma classified?
No laboratory or radiographic tests are necessary for this condition.
Clinical evaluation of the patient determines the type and grade of rhinophyma. The severity and sub-types of rhinophyma get classified in different ways. The first is a division into four clinical variants: glandular, fibrous, fibroangiomatosis, and actinic:
glandular rhinophyma: is primarily due to the expansion of sebaceous glands
fibrous rhinophyma is due to hyperplasia of connective tissue
fibroangiomatous rhinophyma contains fibrosis, telangiectasias, and inflammatory lesions
actinic rhinophyma: elastic fibers grow in nodular masses, producing disfigurement
an additional severity scale, defined by freeman et al. In 1970, is also helpful. Beginning with early vascular type, rhinophyma progresses to:.
What are the treatment options for rhinophyma?
Rhinophyma is a cosmetically deformative condition with unmet needs - both in understanding etiology and in treatment options, says deborah s. Sarnoff, m. D. , clinical professor of dermatology, nyu langone school of medicine, new york, and director of dermatologic surgery, cosmetique dermatology, laser & plastic surgery, new york. Related: topical rosacea cream creates new treatment paradigm “rhinophyma is a very embarrassing and humiliating problem with enormous negative psychosocial implications resulting from its disfigurement and alleged association with alcohol use, and it can also have functional consequences, interfering with breathing, sleeping, eating, drinking and, even, vision,” dr. Sarnoff says. “in recent years there have been some medical advances for masking and controlling the redness associated with rhinophyma, but surgery is still the only option for correcting the deformity. The field is wide open for researchers who are interested in developing new modalities for rhinophyma prevention and treatment,” she says.
First, your doctor completes a physical exam to look for signs of rhinophyma. If they suspect this skin condition, further testing is necessary for an exact diagnosis. Your doctor may take a small sample of the skin cells on your nose to send to a lab for biopsy. This is especially important if your doctor tries treatment options and your condition doesn’t improve. .
Reassure patients of the benign nature of the condition and the relative rarity of any complications (including development of rhinophyma). Avoid precipitating or aggravating factors for their trigger factors of flushing. Facial massage may reduce oedema. Sunscreens should be applied daily. Avoid astringents, toners, menthols, camphor, waterproof cosmetics requiring solvents to be removed, or products containing sodium lauryl sulfate. Judicious use of cosmetics may improve appearance significantly and, in doing so, greatly reduce distress. If the skin is dry use emollients (hypoallergenic and non-comedogenic emollient creams). Avoid topical steroids. Mild-to-moderate rosacea should be treated with a topical preparation. Topical metronidazole 0.
Glandular rhinophyma refers to an enlargement of the sebaceous glands over the nose. To note, sebaceous glands secrete an oily substance called sebum that maintains suppleness of the skin and prevents its drying. The surface of this type of rhinophyma is pitted or indented and the swelling is asymmetrical. When the skin surface is compressed between the fingers, there may be secretion or oozing of sebum, along with dead skin cells and bacteria. The nasal skin may acquire a secondary bacterial infection that can lead to complications such as scarring.