Rhinophyma is a form of rosacea that primarily affects the end of the nose, causing extreme thickening and reddening of the skin. People with rhinophyma have bulbous noses with enlarged pores that sometimes emit oil or sebum. Although rhinophyma is not painful and does not typically interfere with breathing, many people feel self-conscious about its appearance. Several noninvasive treatments are available for reducing signs of rhinophyma, such as dermabrasion and cryotherapy. Most people require repeated sessions because the chronic condition recurs.
Causes of Rhinophyma
Dermatologists do not know what causes rhinophyma but believe it is a subtype of rosacea, which often causes signs similar to but less severe than rhinophyma. Mostly seen on the cheeks and chin, rosacea symptoms include bright red skin, pimples, and swelling. The pathophysiology of rhinophyma involves the abnormal growth and overactivity of sebaceous glands; this latter issue causes inflammation.
Signs and Symptoms of Rhinophyma
In addition to severe redness, thickened, purplish skin, and swelling, rhinophyma significantly alters the shape of the nose’s tip and sometimes the sides of the nose. People with advanced rhinophyma have bulbous noses, skin scaling, excess oil secretions, and sensitivity to extreme temperatures. Rhinophyma is not painful, but touching affected areas may cause discomfort.
Risk Factors for Rhinophyma
Men over 50 have the highest risk of developing rhinophyma, especially if they already have rosacea. Men with Scandinavian, Irish, or Eastern European ethnicity are also more prone to rhinophyma. No definitive research has shown rhinophyma to have a genetic component. However, men with family histories of rosacea may be at risk for rhinophyma. While risk factors are otherwise the same for men and women, doctors rarely diagnose rhinophyma in women.
How is Rhinophyma Diagnosed?
A dermatologist can readily diagnose rhinophyma just by examining the skin. The presence of a bulbous growth on the nose, skin scarring and pitting, and telangiectasias (broken blood vessels and spider veins) clinically indicate rhinophyma. Doctors may take a skin biopsy to check for precancerous or cancerous conditions, or if the condition does not respond to treatment.
Treatment for Rhinophyma
Dermatologists may treat severe rosacea with retinoids or antibiotics. Generally, rhinophyma does not respond well to these medications.Oral or topical antibiotics may reduce inflammation and redness but will not eliminate rhinophyma. Using over-the-counter moisturizers or anti-oil products may help prevent skin from becoming too dry or too oily.
Surgical Procedures for Treating Rhinophyma
Surgery is a good option for people who experience abnormally rapid growth of blood vessels and tissues due to rhinophyma. Cryotherapy is a long-term treatment that involves freezing and destroying abnormal tissues. Dermatologists can also cut away excess tissue. Another treatment option for mild to moderate rhinophyma is dermabrasion, an exfoliating technique that uses dermatological rotation devices to remove thin layers of skin.
Unless treated, rhinophyma may worsen, producing bleeding lesions that become infected. Symptoms of this complication include increased swelling, soreness, and pus-filled bumps. About five out of 100 people with rhinophyma develop basal cell carcinoma. The visibility of rhinophyma can also cause psychological issues. Emotional stress combined with self-consciousness can lead to depression, social anxiety, and isolation.
Skin Conditions Similar to Rhinophyma
Early symptoms of rhinophyma resemble other skin conditions, such as:
- Seborrheic dermatitis
- Pustular folliculitis (inflammation of the hair follicles)
- Perioral dermatitis (rash around the mouth)
A dermatologist should inspect eruptions of bumps or pimples, redness, swelling, or visible spider veins across the nose. Experts recommend people avoid using over-the-counter products on suspected rhinophyma, as these could worsen symptoms.
Alcohol and Rhinophyma
Years ago, doctors thought heavy drinking caused rhinophyma, and the condition was known colloquially as “drinker’s nose” or “alcoholic nose.” Dermatologists now know that drinking may exacerbate symptoms of rhinophyma, but it does not cause the disorder. People who consume alcohol long-term often have enlarged blood vessels in their neck and face, along with reddening and flushing of the face. However, this is due to alcohol’s effects on the circulatory system and not rhinophyma.
Minimizing Symptoms of Rhinophyma
Triggering and worsening of rhinophyma symptoms may be caused by
- Applying astringents, camphor, or waterproof cosmetics to affected areas
- Applying topical steroids to rhinophyma pustules
- Using products like body wash or bubble bath that contain sodium lauryl sulfate
- Exposure to sunlight
To avoid aggravating rhinophyma, use sunscreen and hypoallergenic emollients. Some people find that facial massages help reduce swelling around the nose by increasing circulation to affected tissues.