Rhinophyma is a rare skin disorder characterized by a large, red, bumpy nose. It’s sometimes called “bulbous nose” or “phymatous rosacea.” The exact cause is unknown, but it typically occurs in very severe cases of rosacea.
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 with pus called pustules, may appear on your face as the disorder progresses. According to the National Rosacea Society (NRS), more than 16 million Americans are affected by rosacea.
Rhinophyma typically appears in the later stages of rosacea and forms gradually over several years. The outcome is usually a large mass on the lower half of your nose, which creates a very noticeable disfigurement in most cases.
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. The condition occurs in people who drink alcohol and those who don’t drink alcohol.
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 stage of rosacea, which typically happens between the ages of 25 and 50.
You’re at a higher risk for rosacea and rhinophyma if you have:
- fair skin
- lighter-colored hair
- blue or green eyes
- a family history of rosacea
Rhinophyma usually occurs at a more advanced stage of rosacea. You may see some of the following symptoms in the earlier stages of rosacea:
- random facial flushing
- red, blotchy areas in the center of your face
- 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
- conjunctivitis, which is characterized by redness inside your eyelids
- blepharitis, which is an inflammation or infection of hair follicles on your eyelid
Symptoms can get worse as your rosacea develops. 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 sweat 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. Symptoms can alternate between periods of flare-ups and absence.
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.
Rhinophyma can be treated with medicines or surgery. You and your doctor can decide which treatment option would be best for you:
Rhinophyma may respond to medication if it’s diagnosed in its early stages. Some medications are successful in treating a variety of symptoms related to rosacea, including:
- oral antibiotics to reduce inflammation and redness, such as tetracycline, erythromycin, or minocycline
- topical medications that help minimize swelling, such as metronidazole gel or cream, tretinoin, benzoyl peroxide, or azelaic acid
- oral capsules that prevent skin glands from producing oil, such as oral isotretinoin
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 can restore the appearance of your nose:
- the scalpel, which is a traditional surgical method
- laser resurfacing with YAG or Argon laser
- cryosurgery, which uses extremely cold temperatures to freeze and remove abnormal tissue
- electrosurgery, which uses a high-frequency electrical current to heat and destroy unwanted 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
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.
Talk to your doctor about long-term treatment options to help ease symptoms and avoid future flare-ups. Non-surgical and surgical treatments 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.
There’s no known way to prevent rhinophyma. However, some factors can increase blood flow to the skin’s surface and aggravate rosacea, which is the underlying cause of rhinophyma. You may be able to slow the progression of symptoms by avoiding these triggers:
- hot foods and beverages
- spicy foods
- very hot or very cold temperatures
- exposure to sunlight
- emotional stress
- hot baths
- medications that dilate your blood vessels
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 with 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. You can also find more information at www.healthline.com/health/skin/rosacea.