Rhinophyma

Rhinophyma is a skin disorder that primarily affects the nose, leading to its characteristic bulbous, irregular and enlarged appearance. This condition falls under the spectrum of rosacea, a chronic inflammatory skin disease. While rhinophyma is more commonly seen in men, it can occasionally affect women, typically appearing in middle age.

Symptoms and Clinical Presentation

The hallmark symptom of rhinophyma is the gradual thickening of the skin on the nose, resulting in a swollen, uneven texture. The nose may also appear red, particularly in the early stages, due to persistent inflammation and dilation of blood vessels. Over time, the skin can become more irregular and develop prominent pores, giving it a “peau d’orange” or orange peel-like appearance.

In severe cases, rhinophyma can cause nasal obstruction and difficulty breathing due to the sheer bulk of the affected tissue. The condition may also lead to psychological distress and a negative impact on self-esteem, as the facial appearance can be significantly altered.

Causes and Risk Factors

The exact cause of rhinophyma is not fully understood, but it is believed to be linked to rosacea. Rosacea itself is thought to arise from a combination of genetic predisposition, environmental triggers, and abnormal immune responses. Factors such as prolonged sun exposure, alcohol consumption, spicy foods, and stress may exacerbate both rosacea and rhinophyma.

Treatment Options

Treatment for rhinophyma typically involves a combination of medical therapies and surgical interventions, tailored to the severity of the condition and individual patient preferences. Here are some commonly employed approaches:

Oral medications

Isotretinoin: in milder rhinophyma, this is often a good starting point. Isotretinoin is a vitamin A tablet, that may help the texture, pores, and size of less advanced cases of rhinophyma.

Laser Therapy

Ablative laser resurfacing: Dr Manoharan will often use a combination of CO2 and Erbium:YAG lasers to debulk and sculpt rhinophymatous noses. The procedure is done under light sedation, and takes from 30-60min, and recovery time can range from 2-4 weeks. Once recovered, a maintenance routine of skincare and medications can be prescribed to minimise the risk of recurrence.

Pulsed dye laser (PDL): Targets blood vessels, reducing redness and improving overall appearance, after the initial resurfacing procedure.

Surgical Interventions

Excision and sculpting: In more advanced cases, surgical techniques may be employed to physically remove excess tissue and reshape the nose. This is often combined with laser resurfacing to finesse results and provide the most natural and cosmetically pleasing results.

Maintenance and Follow-up

Long-term management of rhinophyma often requires ongoing skincare, including gentle cleansing, moisturizing, and sun protection. Low dose vitamin A tablets for either a short course or maintenance regime will often be prescribed to improve texture further and minimise risk of rhinophyma recurrence.

Regular follow-up visits with a dermatologist are crucial to monitor the condition and adjust treatment as necessary.

Dr Manoharan has been treating rhinophyma for 15 years, and is aware of the significant psychological impact the condition has on patients. Over this time, he has developed a combination treatment programme for patients with all degrees of rhinophyma, combining medicines, surgery and laser.

Rhinophyma is a challenging condition that can significantly impact a patient’s quality of life. While it may not pose serious health risks, its cosmetic implications can be profound. Early intervention and a comprehensive treatment plan involving medical therapies, laser treatments, and surgical techniques can effectively manage symptoms and improve aesthetic outcomes.

For individuals experiencing symptoms suggestive of rhinophyma, consulting a dermatologist is essential to receive a thorough evaluation and develop a tailored treatment plan suited to their needs.

Remember, each case of rhinophyma is unique, and treatment approaches may vary. Dr Manoharan can provide expert guidance and support throughout the management process, ensuring the best possible outcome for their patients.