Medical News Today: What is rhinophyma?

Rhinophyma is a skin disorder that causes the nose to become enlarged and bulbous. The nose may look red, swollen, and distorted.

The condition is a subtype of rosacea, an inflammatory skin disease. Some people with rhinophyma may also experience symptoms of other rosacea subtypes.

Other subtypes of rosacea cause redness and small, pus-filled bumps on the face, commonly on the cheeks, chin, and nose.

Whereas other rosacea symptoms tend to flare up and then subside, people with rhinophyma may find that their nose continues to grow. Researchers believe that rhinophyma can develop over time due to untreated rosacea.

Causes

Rhinophyma <br>Image credit: M. Sand et al, Cutaneous lesions of the nose, 2010</br>
Risk factors for rhinopehyma include a family history of rosacea, being male, and being middle-aged.
Image credit: M. Sand et al, Cutaneous lesions of the nose, 2010

The exact cause of rhinophyma is unknown. In the past, some people believed that alcohol consumption could lead to the condition.

There is no proven link between rhinophyma and alcohol, but alcohol and caffeine can both temporarily dilate blood vessels, and this seems to make rhinophyma worse.

As a result, many people will cut back on drinking alcohol when they have rhinophyma, despite the lack of evidence suggesting that this is necessary.

Other risk factors for rosacea and rhinophyma include:

  • having fair skin
  • being male
  • being middle-aged
  • having a family history of rosacea

Rhinophyma is most common in men between the ages of 50 and 70.


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Symptoms

The primary symptom of rhinophyma is a change in the color and shape of the nose. Over time, the tip of the nose may turn a deep red. It can also grow in odd directions and appear misshapen or bulbous.

Many people experience other symptoms, including:

  • lumps on the nose due to the growth of extra connective tissue
  • red or purplish discoloration
  • enlarged pores
  • thickened skin
  • scarring or pitting
  • dry or oily skin

Rhinophyma tends to occur in people with severe rosacea, so many people experience other rosacea symptoms too. These may include:

  • sensitive skin
  • red patches
  • facial flushing
  • bumps that look like pimples, which may flare up and then subside
  • telangiectasia, or visible blood vessels in the affected skin, including the nose, chin, or cheeks

Diagnosis

Rhinophyma typically begins following a rosacea diagnosis.

When rosacea is in its early stages, people often confuse it with conditions such as acne or eczema. It is easier to diagnose rosacea as the condition progresses.

The characteristic appearance of rhinophyma often makes it easy to diagnose with just a visual examination.

However, doctors may still run tests in some cases if symptoms do not respond to treatment. They may also take a biopsy to check for any worrisome changes or malignancy in the cells.


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Treatment

Rhinophyma of the nose <br>Image credit: James Heilman, MD, 2013</br>
A doctor can treat rhinophyma with medication or surgery.
Image credit: James Heilman, MD, 2013

There are a few different treatments for rhinophyma, depending on the progression of the symptoms.

Doctors typically treat rosacea with antibiotics and retinoids, but rhinophyma may not respond to the same treatments as other subtypes of rosacea.

Medications

Oral isotretinoin is often the first line of treatment. It is more likely to be beneficial if the rhinophyma is at an early stage or if the symptoms are not severe.

The primary aim of medication is to treat the underlying rosacea. Oral or topical antibiotics may reduce redness or inflammation in the area.

Common antibiotics for treating rosacea include:

  • tetracycline
  • metronidazole
  • erythromycin

Azelaic acid and other topical medications, such as cyclosporine, may help to minimize inflammation and redness too.

In some cases, doctors also recommend moisturizers or medications that help prevent the skin from drying out or becoming oily.

Surgery

Surgery is often the best option for long-term treatment of rhinophyma. As the tissues and blood vessels in the area keep growing, it is crucial to perform surgery as early as possible to prevent permanent disfigurement.

There are several surgical treatment options for rhinophyma, including:

  • Dermabrasion, which removes excess layers of skin.
  • Cryosurgery, which freezes and destroys unwanted or abnormal tissues.
  • Sharp excision, where doctors cut away the growth or excess tissue with a scalpel.
  • Carbon dioxide laser resurfacing, which may allow wounds to heal faster than using a scalpel.

Each surgical option has potential risks, so doctors will discuss all of the possible complications with the individual before helping them to decide on a procedure. Doctors may also recommend a combination of two or more techniques.

A person’s choice of surgical treatment can also vary according to the results they want to achieve, which may involve:

  • removing growths or excess layers of skin
  • reshaping a disfigured nose
  • reducing the appearance of tiny, superficial blood vessels in the area
  • improving the overall look of the skin

Lifestyle tips

Some lifestyle changes may help to manage symptoms. These include avoiding the following:

  • spicy foods
  • smoking tobacco
  • alcoholic drinks
  • caffeinated drinks
  • rubbing the face
  • too much sunlight
  • extreme temperatures

Eliminating these factors may help to reduce the appearance of blood vessels or redness for some people.


Outlook

Rhinophyma is a benign condition initially, but proper diagnosis is essential, as there is a small chance that the growth may become malignant.

One study estimated that 3–10 percent of people with rhinophyma have occult basal cell carcinoma, a type of cancer.

Without treatment, severe rhinophyma may lead to deformity, which can cause embarrassment or distress. Successful surgical treatment can help to prevent this.

There is currently no cure for rhinophyma, and the symptoms can return after surgery.

Long-term medication and other treatment options, such as regular dermabrasion, may help.

Treating rhinophyma as early as possible will give the person the best chance of avoiding permanent disfigurement and prolonged symptoms.

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