Rosacea is a chronic skin condition where the skin breaks out into reddish pus filled pustules on the face. This happens due to the inflammation of the hair follicles and the sweat glands. One of the subtypes of rosacea is Rhinophyma.
Rhinophyma is a special subtype of rosacea where the lesions are most prominent on the nose of the individual, even though they may also be present on other areas of the face and neck. This condition is also called phymatous rosacea, potato nose and bulbous nose. The last two names are due to the fact that the nose takes on a bulging appearance.
Rhinophyma generally affects the tip of the nose but even the skin on the bridge of the nose and sides may be affected. Some rare cases affect the ears also.
Symptoms of Rhinophyma
The following are the symptoms to identify Rhinophyma and to differentiate it from other forms of rosacea:
- The facial skin takes on a reddish appearance and red blotches could be there in the centre of the face and the area surrounding the nose.
- Presence of dry and thickened skin on nose and around the nose.
- The nose develops a bulbous appearance and can appear out of shape.
- As the skin continues to thicken, the nose becomes more deformed in appearance.
- Presence of multiple papules and pus filled pustules on the nose and around it.
- Tiny but prominent red blood vessels on the nose and cheeks swell up (Telangiectasia). Some of the larger blood vessels may also swell up, giving a purplish hue to the nose (Venulectasia).
- Skin may be pitted due to inflamed pores and may have a scarred appearance.
- Sometimes the surface of the skin can be waxy and yellow due to the oil secretions.
Causes of Rhinophyma
The exact cause of rhinophyma is unknown. But the rosacea can be triggered by many factors. It is important to be aware of these risk factors so that they can be avoided and hence, the symptoms of rhinophyma need not get aggravated.
Risk Factors related to Rhinophyma
Rhinophyma has many risk factors. Exposure to these may cause further flare up of the sweat glands and inflammation of the hair follicles. The risk factors involved in rhinophyma are:
- Presence of chronic acne during adolescence.
- Excessive alcohol consumption.
- Exposure to heat via working conditions like kitchens and factories.
- Consuming hot and spicy foods that increase heat in the body.
- Consuming hot liquids and beverages.
- Emotional stress, tension and depression.
- Family history of rosacea.
Diagnosis of Rhinophyma
The doctor will diagnose rhinophyma by enquiring about the medical history of the individual and through a physical exam. The skin can be examined using dermascopy which uses a special magnifying lens. A Wood’s Lamp examination may also be suggested which uses UV light to examine skin to mainly notice any changes in pigmentation.
A skin biopsy may also be done to check whether the inflammation is malignant or not. A portion of the affected area will be inspected in a laboratory to check for this.
Differential Diagnosis of Rhinophyma
There are certain other dermatological conditions which can be confused with rhinophyma. Therefore the examination of symptoms by a doctor becomes very important. Some of the conditions which could be confused with rhinophyma are:
- Seborrheic dermatitis
- Perioral dermatitis
- Different forms of pustular folliculitis
- Different forms of photodermatoses
Complications of Rhinophyma
It is a chronic condition that lasts for a very long period of time. If the rosacea worsens due to aggravation, the signs and symptoms also progressively become worse.
These are some of the possible complications of rhinophyma:
- If the lesions ulcerate and bleed, there could be a chance of bacterial or fungal infection.
- As there are many lesions and the nose also looks disfigured, the individual may become very self conscious of his or her appearance. This could cause issues with self esteem and self image.
- The emotional stress caused by this could lead to symptoms of depression and social withdrawal.
- If left untreated, the symptoms become worse.
- There is a small risk of skin cancer, especially basal cell carcinoma. About 5% of people with rhinophyma suffer from this.
Prognosis of Rhinophyma
Rhinophyma shows good prognosis with treatment. But as it has a recurring nature, the signs and symptoms can recur even after the condition initially goes away with treatment.
Treatment of Rhinophyma
It is best to consult the doctor to decide the best course of treatment. Early medical treatment prevents disfigurement. The following are the treatment options:
The symptoms of rhinophyma usually do not respond well to medicines. Topical medicines like isoretinoin are taken to reduce redness and inflammation. Oral capsules may be taken to prevent excessive oil production from the glands. But generally, medication is not very successful in treating rhinophyma.
Surgery is the most preferred method for treating rhinophyma. Many people with rhinophyma opt for this because of concerns about their appearance.
Disfigurement of the nose happens because the nasal tissues have overgrown and the blood vessels of the nose have become enlarged. Surgery removes the overgrown tissues, minimizes the enlarged blood vessels and reshapes the nose if it is disfigured.
Surgery can be done with a laser or with a scalpel. Dermabrasion can be done where the skin surface is scraped using a brush. Dermaplanning may also be done where the thickened skin is removed by shaving the affected area.
Prevention of Rhinophyma
Avoiding rosacea triggers
The main way to prevent rhinophyma is to know what triggers the aggravation of rosacea symptoms and to then avoid those triggers. The following are a list of probable triggers to be avoided:
- Hot liquids
- Spicy foods
- Very hot and extreme climates
- Vigorous exercise
Keeping skin moisturized
A hypoallergenic skin moisturizer can also be used to prevent skin from drying. Sunscreen with a minimum of SPF 15 or more with UV/UB protection can be used.
Rhinophyma Frequently Asked Questions
At what age can rhinophyma occur?
Rhinophyma can affect the individual at any age. But it is seen more in adults, between the ages of 50-75 years.
Who are more affected by rhinophyma?
Rhinophyma is seen more in men than women. It is rarely seen in females though it does affect women as well. It is more common among fair skinned individuals. It is said to be more frequent among the North European populations.
How is the severity of rhinophyma classified?
The severity of rhinophyma can be graded on a clinical scale from 1-3. In all three grades of rhinophyma, the follicular openings are prominent. However, grade 1 rhinophyma has very less skin thickening, Grade 2 rhinophyma has mild skin thickening and Grade 3 rhinophyma has evident skin thickening. In Grade 3 rhinophyma, the sebaceous glands are overactive and the nose shape also changes.
Rhinophyma is a type of rosacea where pus filled lesions form on and around the nose. The nose appears bulbous in nature and this condition is best treated through surgery.