Rhinophyma

What is rhinophyma?

Rhinophyma is a skin condition affecting the nose in which the skin is thickened and the sebaceous (oil) glands are enlarged. The skin appears skin coloured or red and often has prominent blood vessels, which may be thin and red (telangiectasia) or larger and purplish in hue (venulectasia). The affected skin may be bulbous, pitted due to prominent pores (which may ooze sebum or contain a scaly plug), and scarred.

Typically, rhinophyma affects the tip of the nose, although the sides and skin on the top of the nose can also be involved. Rhinophyma can be cosmetically unsightly as skin thickening may result in irregular nodular growth and deformity of the nose.

Rhinophyma is a type of rosacea. Other forms of rosacea may or may not be present [1]. Occasionally, rhinophyma is preceded by acne.

Grade 1 

Grade 2 

Grade 3 

See more images of rhinophyma.

What is the cause of rhinophyma?

The cause of rhinophyma is not fully understood. Theories include:

• Enlarged blood vessels may predispose to skin thickening [1].
• Vascular instability may lead to leakage of fluid into the tissues. This subsequently triggers inflammation and scarring [2].

Other forms of phymatous rosacea

Rhinophyma occurs in a subgroup of rosacea known as phymatous rosacea. Phymatous rosacea can also affect the following sites:

• Chin (gnathophyma)
• Ears (otophyma)
• Eyelids (blepharophyma)
• Forehead (metophyma).

How is the severity of rhinophyma classified?

Rhinophyma, along with other forms of phymatous rosacea, is graded on a clinical scale of severity from 1 to 3 [1].

• Grade 1: prominent follicular openings with no skin thickening
• Grade 2: prominent follicular openings with mild skin thickening
• Grade 3: prominent follicular openings, skin thickening and overactive sebaceous glands and nodular nasal contour

Who gets rhinophyma?

Rhinophyma predominantly affects male patients. The male-to-female ratio in patients with rhinophyma ranges from 5:1 to 30:1. This is possibly due to androgens (male hormones) [2].

What are the treatment options for rhinophyma?

Non-surgical management

Treatment of rosacea may inhibit the progression of rhinophyma but this has not been conclusively confirmed [2].

• Topical metronidazole
• Topical azelaic acid
• Topical retinoids
• Oral tetracycline antibiotics

The most effective medical treatment appears to be systemic isotretinoin, which can reduce the bulk of rhinophyma [3].

Surgical treatment

Techniques used to improve the cosmetic appearance of rhinophyma include:

• Dermaplaning (excision of thickened skin by shaving off the surface)
• Dermabrasion (scraping the surface skin)
• Cryotherapy (freezing)
• Laser resurfacing (CO2 , Argon, Nd:YAG, Er:YAG)
• Electrosurgery

Are there any complications from rhinophyma?

Basal cell carcinoma is a common form of skin cancer that has been reported to arise in rhinophyma. However, rhinophyma is not considered a precursor for malignancy [1].