Rhinophyma - Definition, Causes, Symptoms and Treatment

A Skin Disease That May Cause Progressive Nose Tip Growth and Deformation: Rhinophyma

Rhinophyma Definition

Rhinophyma,Rosacea,copper nose,hammer nose,hypertrophic rosacea,potato nose,brandy nose,whiskey nose,rhinopahty,toper's nose,rum nose,
Rhinophyma, which is a skin problem that we can detect incidentally in patients who come to us for aesthetic nose surgery, is a kind of skin disease that can usually occur in men between the ages of 50 and 70. Although it is a controversial situation, it may occur in the clinical process as a result of severe rosacea (rose disease) disease and progression in relation to Rhinophyma ; It is also thought that rhinophyma may be a part of rosacea (rose disease).

However, there are some differences between rosacea disease and rhinophyma disease. These differences are:

There are differences between the progression of the two diseases. While rosacea disease goes into regression after exacerbations; If the disease is not treated in rhinophyma, it progresses over time.

There are different characteristics in both diseases in terms of gender. While rosacea types are observed at almost equal rates in men and women; Rhinophyma is more common in men.

There are differences in terms of the age at which the disease occurs. While rosacea tends to occur at an earlier age, Rhinophyma is a condition usually observed in older people.

Rhinophyma disease is a type of disease that progresses with the deformation and shape change of the tip of the nose and is usually observed in men with light skin color. The nose of people with this disease has a structure that contains larger, widespread red areas, perforated, bumpy areas in the form of bubbles and roughness compared to other people. The exact cause is not yet resolved. It has been shown that the bone and cartilage tissue of the nose is generally not affected in rhinophyma disease. In rhinophyma disease, the sebaceous glands in the skin and the supporting tissue in the lower part are affected, and hypertrophy occurs in these tissues. As a possible mechanism, it is thought that the sebaceous glands and hair follicles in the skin are exposed to infection with parasites or bacteria in Rhinophyma disease.

Synonyms for Rhinophyma

In patients with rhinophyma, due to the changes in the shape of the nose in the later period, it may cause different names such as "whiskey nose", "gin blossom", "toros nose", "rhinopahty", "toper's nose", "rum-blossom", "rum nose", "brandy nose", "copper nose", "hammer nose", "hypertrophic rosacea" and "potato nose".

Causes of Rhinophyma

The exact cause of rhinophyma is still unknown and controversial.

Although heavy alcohol and caffeine use is thought to widen blood vessels and make this skin disease worse; Rhinophyma has no proven relationship with alcohol.

Some risk factors have been identified for the formation of rhinophyma. These:

- Being fair skinned
- Being middle-aged
- Having a family history of rosacea
- Having a family history of rhinophyma
- Racial predisposition (Rhinophyma is known to occur especially in English, Scottish, Scandinavian and Eastern Europeans. Some races are predisposed to this skin disease)

Rhinophyma Symptoms

The main complaints of patients in rhinophyma disease are roughness on the skin of the nasal tip, the appearance of holes and protruding areas, deformation at the tip of the nose, sometimes the appearance of redness and spotty areas at the tip of the nose, an increase in the volume of the nasal tip over time. Rhinophyma disease is usually seen in patients with severe rosacea. For this reason, some of the symptoms that can be seen in rhinophyma may also occur in mild rosacea patients. Symptoms that can be seen in rhinophyma disease:

- Red and blotchy areas on some parts of the face
- Pimples in redness areas
- Telangiectasias in the nose and vessels
- Sensitivity in skin structure
- Conjunctivitis, redness and inflammation of the eyes
- Blepharitis of the eyelid
- Facial flushing

Some patients with rhinophyma may wait for a long time without realizing the disease and do not receive any health care services. In this case, the symptoms may worsen as the disease progresses, and there may be an increase in the connective tissue and oil glands in the nose.

The following changes may occur in the nose due to rhinophyma:

- Increase in volume at the tip of the nose (usually rough, hole and protruding areas appear)
- Increase in the number of sebaceous glands
- Enlargement of the pores in the nose
- Appearance of a reddish color to the nose
- Thickening of the skin of the nose
- Deformation of the nose shape over time, deformation
- Formation of cavities in the nasal structure
- The appearance of a jagged, curved nose shape

When rhinophyma is not treated, severe deformation of the nasal skin, shape changes, and increase in the above-mentioned symptoms may occur.

Treatment of Rhinophyma 

I do not treat Rhinophyma and I refer my patients to my dermatologist friends who are experts in this field. In most of the patients, treatment is performed for the treatment of existing nasal deformation, smoothing the nasal skin, and reducing the nose. Performing rhinoplasty alone does not provide the treatment of this disease and the patient should be evaluated primarily by a dermatologist. Laser or scalpel surgery can be performed to remove excess tissue from the nasal skin and reshape the nose. A carbon dioxide laser can also be used to shrink tissue. There are procedures that involve peeling or shaving the skin of the nose like an orange peel. Some of my patients request external shaving of the nasal skin for the purpose of both rhinoplasty operation and Rhinophyma treatment at the same time. During the rhinoplasty operation, we dissect and elevate the nasal skin. In other words, subcutaneous blood supply decreases. Since traumatizing both subcutaneous and extracutaneous at the same time can cause serious problems in healing, it is appropriate to plan the treatment of Rhinophyma and an aesthetic nose operation after a 6-month process.

Dr.Chang et al. Here's a link to a very nice scientific article and video prepared by Rhinophyma in which the 5-step treatment approach (Dermabrasion, Dermaplaning, Electrocautery, Laser) is explained (the video is a bit bloody, it may not be suitable for our patients under the age of 18) >> A Safe, Modern Treatment of Rhinophyma: The 5-Step Technique

Precautions in Rhinophyma

There is no surefire way to prevent rhinophyma. However, certain factors increase blood flow to the skin and exacerbate rosacea symptoms.

While Rhinophyma won't cure it, there are some lifestyle changes that can help you manage this skin problem and limit flare-ups:

- Avoiding spicy foods
- not smoking
- Limiting alcohol use
- Avoid high-caffeine drinks
- Avoid too much exposure to sunlight
- Avoiding very hot environments
- Reduction of traumatic impact and friction to the face
- Reducing stress and anxiety

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com 
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47