A 51-year-old woman requests treatment for thickening of the skin of her nose. The condition has been gradually worsening over the past 2 years. She drinks alcohol in moderation and does not smoke. She takes medication for hypertension. Prior treatments for her nasal condition include doxycycline, metronidazole, and topical ivermectin, all of which were ineffectual.
Submit your diagnosis to see full explanation.
Rhinophyma is a disfiguring condition that manifests as progressive thickening of the soft tissue of the nose. The disorder is related to rosacea, and many clinicians consider it to be a severe variant of this disease. The cause of rhinophyma is unknown; postulated etiologies include immune dysfunction, angiogenesis promoted by ultraviolet radiation, or infestation with demodex mites. The condition is more common in men than women.1
Medical treatment with traditional anti-rosacea therapies such as doxycycline and metronidazole may prevent worsening but will not reduce existing hypertrophy. Some studies have demonstrated improvement with isotretinoin.2
Surgical or electrosurgical debulking of exuberant glandular material is the mainstay of therapy.3 Superior results have been reported with CO2 laser ablation.4
Jason Hendrix, DO, is on staff at Reading Dermatology Associates in Reading, Pennsylvania, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
- Bolognia JL, Jorizzo JL, Schaffer JV. Rosacea and related disorders. In: Powell FC, Raghallaigh SN, ed. Dermatology. 3rd ed. China: Elsevier Saunders; 2009:561-569.
- Pohl L, Karsai S, Raulin C. Rhinophyma: Successful treatment with low-dose oral isotretinoin. Hautarzt. 2018;69(10):853-856.
- 3Sadick H, Goepel B, Bersch C, Goessler U, Hoermann K, Riedel F. Rhinophyma: diagnosis and treatment options for a disfiguring tumor of the nose. Ann Plast Surg. 2008;61(1):114–120.
- Comeau V, Goodman M, Kober MM, Buckley C. Fractionated carbon dioxide laser resurfacing as an Ideal treatment option for severe rhinophyma: a case report and discussion. J Clin Aesthet Dermatol. 2019;12(1):24-27.