Rhinophyma: Symptoms, Causes & Treatment

Rhinophyma is a chronic inflammatory condition that affects the tissues of the nose. It can cause redness, swelling, and lumps or masses that slowly grow over time.

As these growths become larger or more numerous, they can sometimes block the nasal passages. Rhinophyma is more common in men over 40 and is often associated with enlargement of the sebaceous glands and connective tissue in the nose.

Factors such as prolonged sun exposure, alcohol consumption, and rosacea may contribute to its development. Treatment is provided by a dermatologist and may include topical medications, oral isotretinoin, laser therapy, or surgical procedures such as dermabrasion or cryosurgery.

Main symptoms

The main symptoms of rhinophyma are:

• Redness and swelling of the nose

• Fine purple, red, or bluish blood vessels visible on the skin

• Enlargement of the tip of the nose and the nose itself

• Enlarged pores on the nose and face

• Changes in the texture of the nose

• Thickened skin on the nose and the development of fibrous tissue

• Lumps on the nose

Enlargement of the sebaceous glands can also lead to infections and pus formation in the affected area.

If rhinophyma is not properly treated, it can cause nasal obstruction, difficulty breathing, and permanent changes to the appearance of the nose and face. It can also contribute to mental health concerns such as low self-esteem, anxiety, or depression.

If symptoms of rhinophyma develop, it is important to see a dermatologist to confirm the diagnosis and start the most appropriate treatment.

Confirming a diagnosis

Rhinophyma is usually diagnosed clinically by a dermatologist based on symptoms, medical history, a history of rosacea or frequent alcohol consumption, and a physical examination.

In some cases, the doctor may perform a skin biopsy to confirm the diagnosis and rule out other conditions with similar symptoms, such as skin cancer.

Possible causes

The exact cause of rhinophyma is not fully understood, but it is believed to develop from a combination of biological and environmental factors. It is associated with enlargement of the sebaceous glands and connective tissue in the nose, as well as changes in the blood vessels that may contribute to chronic inflammation and swelling.

The main factors that may contribute to the development of rhinophyma are:

• Age (more common between ages 50 and 70)
• Sex (more common in men)
• Fair skin
• Rosacea
• Family history of rosacea or rhinophyma

Blood vessel dilation may also be worsened by environmental factors such as excessive sun exposure or frequent consumption of alcoholic or caffeinated beverages.

Different types

Rhinophyma can be classified into different types according to its characteristics, including:

1. Glandular rhinophyma

Glandular rhinophyma develops due to sebaceous gland hyperplasia, which means the sebaceous glands become enlarged or dilated. This can make the skin on the nose oilier and the pores more noticeable.

Pustules or cysts may also develop on the nose due to a buildup of sebum in the sebaceous glands.

2. Fibrous rhinophyma

Fibrous rhinophyma develops due to an increase in connective tissue in the nose. This causes the skin to become thicker and broader.

3. Fibroangiomatous rhinophyma

Fibroangiomatous rhinophyma is characterized by fibrosis of the tissues of the nose together with increased blood vessel formation and dilation of the blood vessels, known as telangiectasia.

With this type of rhinophyma, the skin on the nose may appear redder or purplish, with more visible blood vessels.

4. Actinic rhinophyma

Actinic rhinophyma develops due to the growth of elastic fibers that form masses and lumps on the nose. It is strongly associated with sun exposure.

In addition to the typical features of rhinophyma, the skin on the nose may also feel rougher.

Treatment options

Treatment for rhinophyma should be guided by a dermatologist and varies depending on the type of rhinophyma and the severity of symptoms.

The main treatments for rhinophyma are:

1. Topical medications

Topical medications such as tretinoin or azelaic acid may help reduce skin inflammation and improve the appearance of the nose.

Other topical medications that may be prescribed include ivermectin (Soolantra) or metronidazole, especially when the person also has rosacea.

In some cases, the doctor may also prescribe topical or oral antibiotics, such as doxycycline, to help reduce acne-like nodules or pus in the affected area.

2. Isotretinoin

Isotretinoin is an oral retinoid that may be prescribed off-label for rhinophyma because it reduces sebum production and the size of the sebaceous glands, which may improve symptoms and the appearance of the skin.

According to the FDA, this medication can cause severe birth defects and is therefore distributed in the US through the iPLEDGE REMS program to reduce the risk of embryo-fetal toxicity.

3. Laser therapy

Laser therapy using a fractional CO2 laser or argon laser may be recommended for rhinophyma.

According to the American Academy of Dermatology, laser surgery may be used to remove excess thickened tissue and reshape areas affected by rhinophyma.

Laser treatment can also reduce small visible red blood vessels on the nose and cheeks, improving the appearance of the skin.

4. Electrosurgery

Electrosurgery is a treatment for rhinophyma that removes excess tissue and helps reshape the nose.

This procedure is performed by a dermatologist under local anesthesia. An electrical current is applied to the skin using an electrosurgical device, generating heat within the tissue.

5. Dermabrasion

Dermabrasion is a treatment for rhinophyma performed by a dermatologist using a small device with a diamond-tipped attachment that mechanically removes the outermost layer of the skin.

6. Cryotherapy

Cryotherapy is performed by a dermatologist using liquid nitrogen to freeze the skin and remove affected tissue from the nose, improving the appearance of rhinophyma.

7. Surgical decortication

In more severe cases of rhinophyma, the doctor may recommend a more invasive procedure known as surgical decortication. This procedure involves surgically removing excess thickened tissue from the nose to help restore its shape.

If cancer is suspected, the removed tissue is sent to a laboratory, where the cells are examined to determine whether tumor cells are present.