What is a rhinophyma?
A rhinophyma is a tuberous, benign skin change of the nose, which may occur in the severe form of the skin disease rosacea – the so-called rosacea phymatosa.
In the case of rosacea (also: rosacea), the facial skin is basically subject to a continuous, progressive inflammation. The cheeks, nose, chin and forehead are most frequently affected.
At first, the disease makes itself felt in the form of a persistent redness. Subsequently, small nodules (papules) and even pus-filled blisters (pustules) often form. If in the course of this the connective tissue and the sebaceous glands also increase excessively (hyperplasia), the picture of irregular skin growths, so-called phyme, develops.
Depending on where these phyme occur, they are named more specifically. For example, they are called gnatophyma on the chin, metophyma on the forehead and otophyma on the ear. By far the most common location for the bulbous growths, however, is the nose, where they are called rhinophyma.
How do you recognize a rhinophyma?
Rhinophyma can be easily recognized by the typical bulbous skin thickenings. Affected skin areas often take on a bluish-reddish color due to underlying vascular changes.
Forms of rhinophyma
There are three main forms of rhinophyma:
- Glandular rhinophyma: In this case, the sebaceous glands in particular are enlarged and their openings widened. Because sebum production is also increased, the skin of the bulbous nose is also very oily.
- Fibrous rhinophyma: In this form, mainly the connective tissue is increased.
- Fibro-angiomatous rhinophyma: In addition to the increase in connective tissue, vascular dilatation (angiectasia) and inflammation are prominent here. The nose often appears copper-colored to dark red and is usually covered with numerous pustules.
The individual forms cannot always be clearly distinguished from one another – the transitions are fluid.
What is the cause?
A “bulbous nose” is a possible manifestation of the severe form of rosacea. The causes of rosacea are not fully understood. It is assumed that different factors must come together for a rhinophyma to develop.
According to current scientific knowledge, certain genes in interaction with other factors lead to an unregulated superficial vasodilatation, edema and persistent inflammation, which is called rosacea.
Although women are slightly more likely to be affected by rosacea, rhinophyma is five to 30 times more common in men, depending on the study – usually in the fourth or fifth decade of life. Why rhinophyma develops primarily in men is unclear. Experts again suspect genetic causes or male hormones as underlying factors.
In the past, it was wrongly assumed that excessive alcohol consumption was the trigger for rhinophyma. Therefore, it was sometimes called “drunkard’s nose”. However, such a connection has not been scientifically confirmed. Although alcohol is considered a risk factor for rosacea, it is not an explicit trigger of rhinophyma.
Treatment
Before these particular consequences of rosacea on the nose are treated otherwise, various medications are usually used. Appropriate preparations (especially azelaic acid and antibiotics such as metronidazole) are commonly used in the therapy of rosacea.
Isotretinoin is also sometimes suitable for the treatment of rhinophyma in mild cases.
Medications slow down the inflammatory changes and reduce the size of the rhinophyma in some cases, but treatment often extends over several months or years and complete regression of the “bulbous nose” is not guaranteed.
- Dermabrasion: Under anesthesia, the top layer of skin is abraded with a type of milling machine. A special ointment is then applied to speed up wound healing. After about ten days, the resulting scab falls off.
- Dermashaving: This procedure is similar to dermabrasion, but instead of a mill, the scalpel is used.
- Laser procedure: With the help of a high-energy laser, the superficial skin areas of the rosacea nose are removed.
- Electrosurgery: Here the growths are removed with an electric snare.
- Cryosurgery: The excess tissue of the rhinophyma is destroyed with the help of liquid nitrogen.
While entire sections of the nose were removed in the past, today’s surgical procedures are much gentler. The growths of connective tissue and sebaceous glands are removed layer by layer. In the process, the surgeon attempts to restore the original shape of the nose. Complications such as severe scarring or dying cartilage parts (cartilage necrosis) occur only rarely.
As is generally the case with rosacea, it is advisable to avoid all factors that trigger a disease flare-up and possibly aggravate the symptoms, including hot spices, alcohol and strong UV radiation. Read more in the main article Rosacea.
Possible complications
The actual problem arises from the high psychological stress that many of those affected suffer from. A pronounced rhinophyma can literally disfigure a face.
In addition, there are often unjustified accusations of alcoholism from fellow sufferers, who continue to mistakenly think that the rhinophyma is a “drunkard’s nose. Patients then often withdraw from their social environment, which severely impairs their quality of life.
Whether rhinophyma promotes the development of skin cancer is still unclear. However, there is a risk that any cancerous growths may be concealed by the bulbous growths and then only detected at a late stage. Therefore, regular and precise examinations are advisable.
Prognosis
Thanks to modern treatment methods (especially in the surgical field), good optical results are achieved in most cases today.
However, some patience is needed, since after surgery the nose area may still be swollen and covered with scabs. Even if this scab falls off after a few days, the skin remains red for up to twelve weeks in some cases. In addition, the skin on the operated areas is initially thinner than the rest of the facial skin.
All in all, however, the current treatment options can significantly improve the quality of life of those affected.
