Rhinophyma is a rare skin disorder characterized by a large, red, bumpy nose. It is sometimes also called “bulbous nose” or “phymatous rosacea.” The exact cause is unknown. However, this condition typically occurs in very severe cases of rosacea.
Rosacea is a common, chronic inflammatory skin condition. It causes irregular redness or flushing of the face. Pustules (small, red bumps with pus) appear on your face as the disorder progresses. According to the National Rosacea Society, approximately 16 million Americans are affected by rosacea (NRS, 2012).
Rhinophyma typically appears in the later stages of rosacea and forms gradually over years. The outcome is usually a large mass at the lower half of the nose. The physical effects of the condition can be extreme, and may cause embarrassment and social anxiety.
There is no known cause for rhinophyma or rosacea. In the past, it was attributed to excessive alcohol use. However, research has disproven that connection. The condition occurs in people who use alcohol as well as in those who abstain from its use.
Risk factors include gender and age. The condition occurs more often in men than in women. The onset of the initial stage of rosacea typically happens between the ages of 30 and 50. Rhinophyma develops gradually after that. Middle-aged men have the highest risk for developing this condition, according to the journal American Family Phyiscian (Blount & Pelletier, 2002).
You are at a higher risk for rosacea—and subsequently rhinophyma—if you have light skin, hair, and eyes. A family history of rosacea is also a risk factor for the condition.
Rhinophyma usually occurs at a later 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: swelling of tiny blood vessels on your nose and cheeks
- very sensitive skin
- ocular rosacea: a burning or gritty feeling in your eyes
- conjunctivitis: redness inside your eyelids
- blepharitis: inflammation of the eyelids
Symptoms can intensify as 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 pores
- reddish skin tone
- thickening of the outer layers of skin
- waxy, rough, yellowish appearance
The symptoms of rhinophyma become progressively worse if left untreated. They also may occur in cycles. Symptoms can alternate between periods of flare-ups and absence.
The most common complication of this disorder is emotional distress. Rhinophyma can cause severe facial disfigurement as it advances. People with this condition can suffer from intense anxiety due to their appearance. Some may resort to social isolation and reclusion.
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 physician typically can diagnose it without tests. Occasionally, a skin biopsy may be required to confirm the diagnosis.
Rhinophyma may respond to medication if diagnosed in its early stages. Some medications are successful in treating a variety of symptoms related to rosacea, including:
- tetracycline, erythromycin, or minocycline: oral antibiotics to reduce inflammation and redness
- metronidazole, tretinoin, benzoyl peroxide, or azelaic acid: topical medications to minimize swelling
- oral isotretinoin: used for severe acne; prevents the sebaceous glands from producing oil
Enlarged blood vessels and tissue overgrowth can cause disfigurement. This can be permanent unless the affected area is removed. Surgery is the preferred treatment for most cases. It is considered the most effective option for long-term success.
A variety of surgical methods can restore a normal appearance. Surgery can be performed using a scalpel, laser, cryosurgery, electrosurgery, or dermabrasion. Surgical treatment can:
- reshape a disfigured nose
- remove overgrowth of tissue
- minimize enlarged blood vessels
- provide overall cosmetic improvement
Dealing with the symptoms of rhinophyma can cause anxiety and emotional distress. In some cases, surgical treatment can improve appearance and help ease symptoms of anxiety and boost self-esteem. However, the problem may recur 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 National Rosacea Society, many people report improvement in emotional wellbeing and professional and social interactions after they receive effective treatment (NRS, 2012).
Educating yourself and others on the cause of rosacea or rhinophyma may also help remove social stigmas around the disorder. Support groups and networks can connect you to others with various forms of rosacea. They may offer information about coping with the physical and emotional effects of the disorder. The National Rosacea Society is the world’s largest support network for rosacea. Find more information at www.rosacea-support.org.
There is no known way to prevent rhinophyma. However, some factors can aggravate rosacea, the underlying cause of rhinophyma, by increasing blood flow to the skin’s surface. You may help slow down 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 blood vessels