Rhinophyma
Definition
Rhinophyma is a feature of a skin condition known as rosacea.
Rhinophyma is an affliction of the nose which becomes red,
swollen and enlarged. The nose takes on a red/purple coloration
and becomes lumpy and pitted. The nose has a greasy feel
and white material can be expressed from it.
Rosacea is not life threatening but for many individuals
it is lifelong. Rosacea affects the skin and causes persistent
and recurrent inflammation mostly of the skin of the face.
The typical areas involved are the "blush areas"
such as the nose, chin and forehead.
Incidence and Age
Rosacea can affect most age groups. It is quite common,
affecting perhaps one person in a hundred. It is commonest
between the third and fifth decade. It typically affects
fair skinned people and affects women more frequently, but
is more severe in men. Rhinophyma is more common in men.
Causes
The exact cause of rosacea is unknown. Tiny blood vessels
under the skin enlarge and dilate. When this happens they
become visible and produce tiny red lines across the skin
known as telangiectasia.
Symptoms/Signs
Rosacea may start during teenage years with occasional attacks
of flushing of the skin around the nose, forehead, cheeks
and chin. This typically happens in embarrassing or anxious
situations and/or when drinking alcohol or eating certain
foods. During the early twenty's flushing attacks may become
worse and cover a wider area of face. The redness may become
permanent with telangiectasia. In their thirties small pimples
(papules) and small white blisters filled with pus (pustules)
appear in addition to redness. These papules and pustules
can be mistaken for acne. In contrast to acne no blackheads
form.
Symptoms of more severe rosacea can include painful irritation
of the eyelids and eyes and the development of rhinophyma.
Complications of Rosacea
For many people intermittent facial flushing and redness
maybe the only problem. There are some long-term complications
that affect some individuals.
• Rhinophyma - a condition
of irregular enlargement of the soft tissues of the nose.
The nose takes on a red/purple coloration and becomes lumpy
in appearance. The lower part of the nose is typically involved
but the condition may extend to involve the whole nose.
• Eye problems - the
most common eye problem is conjunctivitis (itchy red eyes);
other eye problems include blepharitis (inflammation of
the eyelids) and rarely keratitis (inflammation of the eyeball
itself).
Tests
The diagnosis of rosacea and rhinophyma is usually made
from the appearance alone. No special tests are needed.
Treatment
Medical - no treatment is effective in completely curing
rosacea. The correct early treatment of rosacea can help
to control the condition. Over the counter acne preparations,
perfumed soaps and cosmetics should be avoided. Long-term
therapies with an antibiotic (either as tablets or applied
topically) are the most common treatments. Some doctors
are using newer agents derived from vitamin A.
The development of rhinophyma may be prevented by effective
medical treatment but medical treatments themselves will
not treat an established rhinophyma.
Surgical - the fine dilated red lines known as telangiectasia
can be covered in some instances by make up. The removal
of telangiectasia may be achieved using laser treatments.
Rhinophyma can be treated surgically. The surgical procedure
involves either a local or general anaesthetic. Once the
patient is anaesthetised the nose can be planed and sculpted
using a scalpel blade to the desired shape. Once the desired
shape is achieved the nose is dressed. The dressing sticks
to the nose and takes about two weeks to spontaneously separate.
Under the dressing a new layer of skin forms on the nose,
once this is complete the dressing separates spontaneously.
Whilst this procedure is effective there is a risk of recurrence.
More recently carbon dioxide laser has been used to vaporise
the rhinophyma tissue and this appears to be effective.
