Introduction
A deformity that affects the nose name being self-explanatory terminology derived from the Greek words, rhinophyma ‘rhis’ means nose, and ‘phyma,’ which means tumor. This is characterized by the thickening of the skin on the nose due to the enlargement of the sebaceous glands.
What Is Rhinophyma?
A skin condition that causes the skin on the nose to thicken due to the enlargement of the sebaceous glands. The skin appears red, bulbous, and pitted. The red color is due to the prominent blood vessels on the skin; the blood vessels can also have a purplish hue if they are larger. Pitted appearance is due to the high number of sebaceous glands, which may either ooze sebum or contain a plug. It can be non-esthetic and affects the tip and side of the nose. It can be nodular and irregular in appearance. In some cases, rhinophyma can be a type of rosacea and be associated with other forms of rosacea.
What Is Rosacea?
Rosacea is an inflammatory condition affecting the skin. This causes redness of the face, nasal areas, or cheeks. Red bumps can occur, which may be filled by pus. Rosacea is divided into four main subtypes, and rhinophyma is considered to be the subtype of rosacea. It is believed that long-standing and untreated rosacea can result in rhinophyma, resulting in a large mass on the lower half of the nose.
What Causes Rhinophyma?
Although the exact reason for rhinophyma is not fully understood, several theories have been suggested, such as
1. Vascular Instability: This might cause the fluid to leak into the tissues, which can trigger inflammation and scarring.
2. Enlargement of Blood Vessels: The enlargement of blood vessels can cause the skin to thicken.
3. Subtype of Rosacea: Rhinophyma can occur along with other forms of rosacea. This can be found on other sites such as:
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Ears- Otophyma.
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Chin- Gnathophyma.
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Forehead- Metophyma.
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Eyelids- Blepharophyma.
What Are the Risk Factors for Rhinophyma?
1.Gender: Male predilection.
2. Age: Between 25 to 50 years of age.
It does not exclusively affect a certain group of people but the risk increases in:
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Fair-skinned individuals.
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Racial predisposition in English, Irish, Scottish, Eastern European, or Scandinavian.
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A family history of rosacea has a higher risk for rhinophyma.
What Are the Clinical Features of Rhinophyma?
Rhinophyma is seen in severe cases of rosacea. Symptoms include
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Facial blushing or redness.
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Red areas in the center of the face.
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Telangiectasia of the blood vessels on the nose and cheeks.
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Sensitive skin.
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Ocular rosacea causes a gritty feeling in the eyes, along with conjunctivitis. Eyes become inflamed and red. Blepharitis is also seen along with it.
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Increased production of sebum.
As the symptoms worsen, the connective tissue and sebaceous glands increase. This causes the nose to swell and take a bulbous shape. The skin pores enlarge, and numerous oil glands can be seen. The skin becomes red, and the outer layers thicken. The nose has a rough, waxy, and yellowish appearance. Rhinophyma can appear as the enlargement of the tip or the sides of the nose. Depending on the appearance and incidence of other forms of phymatous rosacea, rhinophyma can be graded as:
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Grade 1: Follicular openings without thickening of the skin.
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Grade 2: Follicular openings with mild thickening of the skin.
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Grade 3: Follicular openings with thickening of the skin, the nodular contour of the nose, and excessively active sebaceous glands.
Rhinophyma mostly affects men. The ratio of men to female ratio can range from 5:1 to 30: 1. The increased incidence of the condition in men can be attributed to androgen hormones.
In some cases, the rhinophyma can progress to basal cell carcinoma. However, rhinophyma is not considered to be a premalignant condition.
How to Diagnose Rhinophyma?
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The rhinophyma can be mistaken for acne in the initial stages if rosacea is not identified.
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Medical history and physical examination are conclusive for the diagnosis of rhinophyma. It does not need specific tests.
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If confirmation is required, a biopsy can be performed if it is not responding to treatment.
How to Treat Rhinophyma?
The treatment options for rhinophyma can be broadly divided into
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Non-surgical.
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Surgical.
Non-surgical Management:
Non-surgical management may not be effective if rhinophyma has progressed. If the rhinophyma is associated with rosacea, the treatment of underlying rosacea can reduce rhinophyma.
Non-surgical management includes
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Topical Azelaic acid.
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Topical Metronidazole.
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Topical retinoids.
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Oral Tetracycline antibiotics.
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Isotretinoin can be the most effective treatment, as it can reduce the bulk of rhinophyma. Isotretinoin is effective in preventing excessive production of oil.
Surgical Treatment:
Surgery is the common treatment for rhinophyma, owing to the enlarged blood vessel and tissue overgrowth, which results in disfigurement. Surgery can help reshape the nose, improve the esthetic appearance, remove tissue overgrowth and minimize the enlarged blood vessels.
Certain invasive and non-invasive procedures can be used to increase the cosmetic appearance, such as:
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Dermaplaning: This is the excision of thickened skin by shaving the surface layer. Dermaplaning is a cosmetic procedure that involves the removal of dead skin build-up and fine hairs.
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Cryotherapy: This is a non-invasive technique for excision; here, the targeted cells are cooled to sub-zero temperatures and then excised. It is a commonly used cosmetic procedure.
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Dermabrasion: This involves the removal of the top layers of skin using a small rotating tool.
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Laser Resurfacing: It can be done using carbon dioxide laser, Argon, Nd: YAG, or Er: YAG.
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Electrosurgery: A technique where heat from an electric source is used to destroy or remove abnormal skin.
Rhinophyma can affect the self-esteem of the affected individual. Hence the treatment is necessary to help improve the appearance and reduce anxiety. Proper follow-up is also necessary, as in some cases, the condition can progress to carcinoma.
Conclusion
Rhinophyma is a skin condition that is often associated with rosacea. This involves the disfigurement of the nose due to the enlargement of the blood vessels and excessive production of sebum. This can pose an esthetic concern for the patient and affect their self-esteem. Treatment of the condition includes surgical and non-surgical management. Non-surgical management involves the use of topical antibiotics and retinoids, while surgical treatment includes laser resurfacing, dermaplaning, or dermabrasion.
