Rhinophyma

Rhinophyma is a condition that causes the increase in volume of the nose, starting from the tip and nasal wings and progressing to the root of the nose. It occurs most commonly among men who are 50 year-olds or older, and is often coupled with rosacea (acne rash that affects the cheeks, forehead and nose).

The exact cause of rhinophyma is still unknown. Doctors believe there are several factors that determine the lobular, irregular appearance of the nose. The mechanism behind this bulbous aspect is the superficial irregular vasodilation of the nose, which causes the appearance of a chronic edema of the dermis, inflammation, fibrosis and increased volume of sebaceous glands. All of these lead to the characteristic appearance of the typical rhinophyma nose:

• Uneven lobes;
• Dilation of multiple superficial vessels;
• Reddish-pink color of the skin;
• Excess sebum;
• Thickened skin;
• Bulbous tip of the nose and enlarged nasal wings.

These changes in nose shape may be associated with respiratory problems due to nasal obstruction.

Very rarely this can affect he the ear or chin.

If the diagnosis is not certain (differential diagnosis with tumorous growths) a biopsy will be done to confirm the diagnosis.

Incorrectly, and currently only encountered in historical mentions, rhinophyma was associated with alcoholism. This correlation led to the social stigmatization of patients with this disease. A study on the correlation between rhinophyma and alcoholism led to the conclusion that patients were not alcoholics, nor did they drink alcohol regularly.

(Rhinophyma - Jake Laun, BS, Jared Gopman, BS, Joshua B. Elston, MD Michael A. Harrington, MD, Department of Surgery, Division of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, Eplasty - Published online 2015 May 1).

In a small number of cases, rhinophyma can become malignant, when basal cell carcinoma appears on the surface of the skin.

The treatment of rhinophyma comprises a multitude of procudures, depending on the size and location of the excrescence. It includes: tangential excision, dermabrasion, cryosurgery, CO2 laser, etc.

Surgery

The purpose of the surgery is to remove excess tissue and restore the natural shape of the nose.

The surgery is performed under general or local anesthesia (for small areas) and consists of tangential excisions of excess tissue, reshaping the nose and covering the defect either with a full thickness skin graft or by per-secundam epithelialization.

Prior to excision, the area is infiltrated with a solution that contains a very low concentration of adrenaline (if there are no contraindications) to control bleeding. In the case of treatment with per-secundam epithelialization, the excision will not span the base of the sebaceous glands, to allow re-epithelialization and an aesthetic healing as much as possible.

How the defect is covered depends on the excised surface and the associated comorbidities.

The skin graft is harvested supraclavicularly (as this area is closer in color to the facial skin), and the donor area is sutured.

It takes 7-10 days for vascular integration of the skin graft or 2-6 weeks for epithelialization of the excised and non-grafted area.

Postoperatively it is recommended to periodically come for a checkup (cleaning, dressing the wound, removal of the suture material), to start applying sun protection cream (SPF 30 or higher), and to massage the affected area with healing creams.

Although rhinophyma is a benign condition, it can lead to major aesthetic deformities, with important psychosocial implications for the patient. The risk that this pathology has to morph into skin malignancies should not be neglected. Although non-surgical treatment options vary, they offer satisfactory results in the early cases of rhinophyma. Surgical treatment remains the only option for the bulky, lobed and unsightly nose.