Rhinophyma

From Orlhns

Rhinophyma is a condition of the external nose caused by hypertrophy of the sebaceous tissue and inflammation of the tissues around the gland over the skin of nose.The word rhinophyma is derived from Greek word "rhis" meaning nose and "phyma" meaning growth.The medical literature has been silent for centuries, but the condition has been well documented in art and literature. It is believed to be a a severe variant of acne rosacea which is a chronic acneform disorder of the pilosebaceous units of the skin. Rhinophyma occurs primarily in males though incidence of rosacea is more common in females. Both the oil-producing (sebaceous) glands and the surrounding connective tissues of the nose enlarge, and thick, knobby bumps may develop. Common in 5th to 7th decade of life. Rarely the skin over the chin too can similarly involved when it is referred to as 'mentophyma'

Contents 1 Cause 2 Pathophysiology 3 Clinical features 4 Treatment 4.1 Medical 4.2 Surgical treatment

[edit] Cause

The exact cause of rhinophyma is unknown though it is believed to be a severe form of acne rosacea. Some other factors in the etiology are

• Infection with Demodex Follicularum (saprophytic parasite)
• Helicobacter Pylorum
• Alcohol - the condition was once associated with heavy alcohol consumption though it has been seen that it occurs with equal frequency in people who do not consume alcohol.
• Blood vessels disorders
• Endocrinal abnormality
• Digestive tract disorder

[edit] Pathophysiology

It begins with accentuation of flush over the nose, forehead, malar prominence & chin causing incresed vascularity, increase skin thickness with cysts and pustules. There is hyperplasia and hypertrophy of sebaceous glands. Ducts elongate, dilate and get plugged resulting in inflammation of the glands.

[edit] Clinical features

It is disfiguring and unacceptable to patients mainly for cosmetic reasons. Sometimes due to gross enlargement can also lead to nasal obstruction. It is a clinical diagnosis.

[edit] Treatment

[edit] Medical

Very early stages of rhinophyma can be addressed medically especially before the fibrosis and disfigurement has set in. Measures include

• avoidance of stimulation factors
• low dose antibiotics for treatment of secondary infections
• keeping area clean
• topical steroids.
• considering it as Rosacea, retinoids and Isotretinoin has been tried

[edit] Surgical treatment

Surgery is main management and includes surgical shaving of the redundant tissue. The depth of shaving is such to leave enough skin adnexal structures available at the wound base to allow for proper re-healing.

• dermaplanning
• dermabrasion
• cryosurgery
• carbon dioxide laser used in a continuous mode
• Harmonic scalpel
• Yag Laser

Radiotherapy role has also been described in few case studies