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Rhinophyma
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Rhinophyma is a benign cutaneous condition that is the result of hypertrophy of the pilosebaceous units of the nasal skin. This overgrowth and subsequent fibrosis can be the end result of rosacea. The Greek word phyma means ‘growth’ and this hypertrophic tissue adds bulk and weight to the nasal skin that can lead to obstruction of air flow and ptosis. Males are more greatly affected than females, 12:1, and the condition is rare among individuals of Asian or African heritage. While most cases arise in the setting of rosacea, it is not always a precursor. While rhinophyma does not predispose the patient to skin cancer, any non-healing or fast-growing lesion should be biopsied to rule out a malignancy.
Management Strategy
The hyperplastic tissue is best treated with ablative modalities. Topical treatment is not effective; while oral antibiotics and retinoids (isotretinoin) may slow the progression, ultimately they do not reduce the bulk of tissue. All ablation treatments are destructive and scarring and hypopigmentation can result. Surgical techniques involve paring the tissue and contouring either with a scalpel or a ‘cutting loop’ of an electrosurgical unit. The Shaw scalpel uses a heated blade to remove the phymatous tissue, in a relatively bloodless field. Energy-based devices such as the CO 2 laser, pulsed dye laser, and yttrium-aluminum-garnet (YAG) lasers can be used to vaporize or refine nasal contours. Liquid nitrogen (cryosurgery) and ionizing radiation have also been used; the former can cause hypopigmentation and scarring, while the latter may induce a skin cancer.
Specific Investigation
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Biopsy is occasionally indicated to exclude malignancy
Rhinophyma and coexisting occult skin cancers
Lutz ME, Otley CC. Dermatol Surg 2001; 27: 201–2.
Rhinophyma can be complicated by the development of a malignancy, which can be difficult to recognize.
Rhinophyma and nonmelanoma skin cancer: an update
Lazzeri D, Agostini T, Pantaloni M, et al. Ann Chir Plast Esthet 2012; 57: 183–4.
In addition to basal cell, squamous cell, and basosquamous carcinomas, rarely, angiosarcoma and sebaceous carcinoma may occur.
Triple approach to rhinophyma
Curnier A, Choudhary S. Ann Plast Surg 2002; 49: 211–4.
The authors report pleasing results in six patients treated by tangential excision for debulking, the use of scissors for sculpting, and mild dermabrasion for final contouring.
Electrosurgical treatment of rhinophyma
Clark DP, Hanke CW. J Am Acad Dermatol 1990; 22: 831–7.
This treatment was inexpensive, associated with few complications, and gave good or excellent cosmetic results in 13 cases.
Surgical management of rhinophyma: report of eight patients treated with electrosection
Rex J, Ribera M, Bielsa I, et al. Dermatol Surg 2002; 28: 347–9.
Eight male patients were treated using radiofrequency electrosurgery to remove thin layers of tissue until the nose shape was recreated. All patients achieved acceptable cosmetic results.
Rhinophyma: “Less is more” and “Old is gold”
Marcasciano M, Vaia N, Rituffo D, et al. Aesthetic Plast Surg 2017; 41(1): 232–3.
Ten patients with moderate-to-severe rhinophyma were treated with decortication with a Valley Lab electrosurgical loop with good results.
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