Successful Treatment of Rhinophyma With Fractionated Carbon Dioxide (CO2) Laser in an African-American Man: Case Report and Review of Literature of Fractionated CO2 Laser Treatment of Rhinophyma

November 2016 | Volume 15 | Issue 11 | Case Report | 1465 | Copyright © 2016

Ekaterina Kraeva BSN,a,b Derek Ho BS,a,b and Jared Jagdeo MD MSa,b,c

aDermatology Service, Sacramento VA Medical Center, Mather, CA bDepartment of Dermatology, University of California Davis, Sacramento, CA cDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY

Abstract

Rhinophyma, a late complication of rosacea (phymatous subtype), is a chronic, progressive dermatological condition. The classic pre- sentation of rhinophyma is nodular, thickened skin over the distal nose, and is often accompanied by underlying erythema secondary to in ammation. Due to the unpleasant aesthetic and dis guring appearance, rhinophyma may be associated with a signi cant nega- tive psychosocial impact, resulting in decreased patient quality-of-life. Treatment of rhinophyma is challenging as topical and systemic pharmacotherapies have shown limited ef cacy. We present a case of a 39-year-old African-American male with long-standing, mild rhinophyma who was successfully treated with two sessions of fractionated carbon dioxide (CO2) laser. We also review the medical literature on fractionated CO2 laser treatment of rhinophyma. To the best of our knowledge, this is the rst report of successful treat- ment of rhinophyma using fractionated CO2 laser in an African-American man (Fitzpatrick VI). We believe that fractionated CO2 laser may be a safe and ef cacious treatment modality for rhinophyma in skin of color patients (Fitzpatrick IV-VI) and early intervention with fractionated CO2 laser to prevent rhinophyma worsening may yield better results than late intervention. J Drugs Dermatol. 2016;15(11):1465-1468.

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INTRODUCTION

Rhinophyma, a late complication of rosacea (phyma- tous subtype), is a chronic, progressive dermatologi- cal condition. The classic presentation of rhinophyma is nodular, thickened skin over the distal nose, and is often accompanied by underlying erythema secondary to in ammation.1 Histopathological findings commonly associated with rhinophyma include dermal thickening, sebaceous gland hyperplasia, increased sebum production, and dilated sebaceous ducts.2 In contrast to rosacea, which typically affects young and middle-aged women, rhinophyma occurs predominantly in middle-aged and elderly men.3 The precise etiology of the disease remains unknown, however, various factors, including colonization of the skin with Demodex folliculorum, androgenic activity, and vasoactive agents have been implicated in the pathogenesis of the disease.1-4 Due to the unpleasant aesthetic and dis guring appearance, rhinophyma may be associated with a significant negative psychosocial impact, resulting in decreased patient quality-of-life.2,5 In addition, severe forms of rhinophyma can lead to functional impairment such as dif culty breathing secondary to obstruction of nasal cavity.2,4 Occult malignancies found within surgically excised rhinophymatous tissue have been reported,

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