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Rhinophyma

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. According to the National Rosacea Society (NRS), more than 16 million Americans are affected by rosacea.

A worldwide expert panel on rosacea has identified four subtypes. The subtypes can range from mild to severe. It isn’t unusual for individuals to have more than one subtype.

Rhinophyma is classified as part of subtype 3 rosacea. It forms gradually over several years and is believed to be the result of poorly treated or untreated rosacea. The outcome is usually a large mass on the lower half of your nose.

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Causes

Causes of rhinophyma

There’s no known cause for rhinophyma. In the past, it was thought to be due to alcohol use, but recent research has disproven that connection.

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Risk factors

Risk factors for rhinophyma

Risk factors include gender and age. Rhinophyma occurs more often in men than in women. The condition gradually develops after the onset of the initial stages of rosacea, which typically happen between the ages of 25 and 50.

You’re at a higher risk for more severe rosacea and rhinophyma if you have:

  • fair skin
  • an Irish, English, Scottish, Scandinavian or Eastern European racial background
  • a family history of rosacea
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Symptoms

Symptoms of rhinophyma

Rhinophyma usually occurs in more severe cases of rosacea. You may see some of the following symptoms in the less severe stages of rosacea or notice other subtypes that include:

  • random facial flushing
  • red, blotchy areas in the center of your face
  • recurrent bumps and pimples, often mistaken for acne
  • telangiectasia, which is a swelling of tiny blood vessels on your nose and cheeks
  • very sensitive skin
  • ocular rosacea, which is characterized by a burning or gritty feeling in your eyes, often along with conjunctivitis, characterized by redness and inflammation of your eye, and blepharitis, an inflammation or your eyelid

Symptoms can get worse as your rosacea progresses. More symptoms arise with the onset of rhinophyma. For example, the connective tissue and oil glands on your nose may increase. You also may notice the following changes to your nose:

  • gradual growth into a swollen, bulbous shape
  • numerous oil glands
  • enlarged skin pores
  • reddish skin tone
  • thickening of the outer layers of skin
  • waxy, rough, yellowish appearance

The symptoms of rhinophyma become worse if they’re left untreated. They also may occur in cycles.

Diagnosis

Diagnosis of rhinophyma

Earlier stages of rosacea can be confused with acne and other skin conditions. However, rhinophyma usually occurs after rosacea is identified.

Rhinophyma has unique characteristics. Your doctor typically can diagnose it without tests. They may be able to make a diagnosis by simply asking about your medical history and performing a physical exam. A skin biopsy may occasionally be required to confirm the diagnosis, especially in rare cases where the condition doesn’t respond to treatment.

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Treatment

Treatment of rhinophyma

Rhinophyma can be treated with medicines or surgery. You and your doctor can decide which treatment option would be best for you.

Medication

Typically, once rhinophyma develops, it doesn’t respond well to medications. Medications may be successful in treating less severe cases and other subtypes of rosacea. These include:

  • topical and oral antibiotics to reduce inflammation and redness, such as metronidazole, sulfacetamide, tetracycline, erythromycin (Erythrocin Stearate), and minocycline (Minocin)
  • topical medications that help minimize inflammation, such as tretinoin (Retin-A) and azelaic acid (Azelex)
  • oral capsules that prevent skin glands from producing oil, such as oral isotretinoin

Surgery

Surgery is the most common treatment of rhinophyma. Enlarged blood vessels and tissue overgrowth can cause disfigurement. This can be permanent if the affected area isn’t removed. Surgery is the preferred treatment for most cases. It’s considered the most effective option for long-term success.

The following surgical treatments and methods are commonly used to restore the appearance of your nose:

  • surgery using a scalpel
  • laser resurfacing with carbon dioxide laser
  • cryosurgery, which uses extremely cold temperatures to freeze and remove abnormal tissue
  • dermabrasion, which uses a small, rotating tool to take off the top layers of skin

Surgical treatment can:

  • reshape a disfigured nose
  • remove overgrowth of tissue
  • minimize enlarged blood vessels
  • improve cosmetic appearance
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Outlook

Outlook for rhinophyma

The symptoms of rhinophyma can cause anxiety and emotional distress for some people. In some cases, surgical treatment can improve appearance and help ease anxiety. However, the problem may reappear after treatment.

When diagnosed with rhinophyma, it’s important to follow up with your doctor. Individuals with this condition are at risk for skin cancer within the affected tissue. The most common type of skin cancer in these cases is basal cell carcinoma. It affects about 5 percent of people with rhinophyma. Some experts argue that rhinophyma is actually a precancerous skin condition.

Talk to your doctor about long-term treatment options to help ease symptoms and avoid future flare-ups and complications.

Early medical treatment along with surgical procedures can reduce symptoms and prevent permanent disfigurement. Treatment that begins in the early stages may have the best results. According to the NRS, many people report improvement in their emotional well-being and professional and social interactions after they receive effective treatment.

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Prevention

How to prevent rhinophyma

There’s no known way to prevent rhinophyma. However, some factors can increase blood flow to the surface of your skin and aggravate rosacea symptoms. Experts recommend avoiding these potential triggers in order to limit flare-ups:

  • hot foods and beverages
  • spicy foods
  • alcohol
  • caffeine
  • very hot or very cold temperatures
  • exposure to sunlight
  • emotional stress and anxiety
  • strenuous exercise

Experts also recommend a healthy skin care routine for individuals with rosacea regardless of the subtype. This includes:

  • regular sunscreen use with SPF 15 or higher and UVA/UVB protection
  • sensitive skin or hypoallergenic skin moisturizer
  • proper eye care when needed such as artificial tears and safe cleansing

Educating yourself and others about the cause of rosacea or rhinophyma may help remove social stigmas around the disorder. Support groups and networks can connect you with others who have rosacea. They may offer information about coping with the physical and emotional effects of the disorder. The NRS is the world’s largest support network for those with rosacea.

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