DERMATOLOGY

Rhinophyma

  • Definition: A skin condition characterized by thickened skin and enlarged sebaceous glands on the nose.
  • Appearance:
    • Skin color: Red or skin-colored.
    • Blood vessels: Prominent, with possible telangiectasia (thin, red) or venulectasia (larger, purplish).
    • Texture: Bulbous, pitted with prominent pores, potentially oozing sebum or containing scaly plugs.
    • Scarring may be present.
  • Affected Areas: Mainly the tip of the nose, but can also involve sides and top.
  • Cosmetic Impact: Can cause irregular nodular growth and nasal deformity.
  • Relation to Rosacea: A type of rosacea, which may or may not coexist with other rosacea forms. Sometimes preceded by acne.

Cause of Rhinophyma:

  • Not Fully Understood
  • Theories:
    • Enlarged blood vessels leading to skin thickening.
    • Vascular instability causing tissue fluid leakage, inflammation, and scarring.

Other Forms of Phymatous Rosacea:

  • Can affect the chin (gnathophyma), ears (otophyma), eyelids (blepharophyma), and forehead (metophyma).

Severity Classification:

  • Grade 1: Prominent follicular openings without skin thickening.
  • Grade 2: Prominent follicular openings with mild skin thickening.
  • Grade 3: Prominent follicular openings, significant skin thickening, overactive sebaceous glands, nodular nasal contour.

Demographics:

  • Predominantly Affects Males: Male-to-female ratio ranges from 5:1 to 30:1, possibly influenced by androgens.

Treatment Options:

  • Non-Surgical:
    • May include topical metronidazole, azelaic acid, retinoids, oral tetracycline antibiotics.
    • Systemic isotretinoin can be effective in reducing bulk.
  • Surgical:
    • Techniques include dermaplaning, dermabrasion, cryotherapy, laser resurfacing (CO2, Argon, Nd:YAG, Er:YAG), electrosurgery.

Complications:

  • Basal Cell Carcinoma: Can arise in rhinophyma but it’s not considered a precursor for malignancy.

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