INTRODUCTION
Rhinophyma is a common, benign, and disfiguring condition characterized by hypertrophy of the nasal sebaceous tissue. The name is derived from the Greek words "rhis" for nose and "phyma" for growth. This condition predominately affects Caucasian males between the fifth and seventh decade of life, with a 20:1 estimated incidence ratio of male to female.1,2 It is rare in the Asian and African populations.2 While less frequent in women, it may present earlier, in the late thirties to early sixties years of age.3
The pathogenesis of rhinophyma is unknown but is suspected to correlate with long-standing rosacea, even classified by some as rosacea's fourth stage.4 Historically, it was thought to be secondary to heavy alcohol consumption; however, studies have found no significant difference between alcohol intake in rhinophyma patients and control groups.
The clinical progression of rhinophyma starts with dilated pores at the nose's distal tip and may advance to severe hypertrophy of sebaceous glands, creating large bulbous nodules. The affected regions typically are the lower distal parts of the nose, such as the nasal tip, ala, and dorsum.5 Severe cases may be at risk of nasal obstruction, sleep apnea, and obliteration of the nasal cosmetic subunits.4,5
Rhinophyma has been classified into four different subtypes based on the clinical appearance: glandular type with increased sebum secretion, fibrous type with connective tissue overgrowth, fibroangiomatous type with edema and telangiectasia, and lastly actinic type with nodular masses of elastic tissue.3 Additionally, these phymatous features may extend beyond the nose, rarely affecting the chin (gnathophyma), forehead (metophyma), ears (otophyma), and eyes (blepharophyma).5
The history of surgical treatments for rhinophyma dates back to 1845, when Johann Friedrich Dieffenbach removed rhinophymatous tissue through vertical and horizontal incisions.2,6 In 1912, Wood removed rhinophymatous skin, followed by skin grafts, which resulted in poor results. Radiation therapy has also been used to decrease the number of sebaceous glands and atrophy of the pilosebaceous units. A study by Skala et al reported significant improvement in rhinophyma following 20 treatments of 40 Gy within one month.7 However, given the increased risk of malignancy with repeated radiation, this treatment modality has fallen out of favor.
Before treatment, a thorough examination is critical to confirm that nasal disfigurement is due to rhinophyma. There have been several reports of neoplasms mimicking rhinophyma, or a
The pathogenesis of rhinophyma is unknown but is suspected to correlate with long-standing rosacea, even classified by some as rosacea's fourth stage.4 Historically, it was thought to be secondary to heavy alcohol consumption; however, studies have found no significant difference between alcohol intake in rhinophyma patients and control groups.
The clinical progression of rhinophyma starts with dilated pores at the nose's distal tip and may advance to severe hypertrophy of sebaceous glands, creating large bulbous nodules. The affected regions typically are the lower distal parts of the nose, such as the nasal tip, ala, and dorsum.5 Severe cases may be at risk of nasal obstruction, sleep apnea, and obliteration of the nasal cosmetic subunits.4,5
Rhinophyma has been classified into four different subtypes based on the clinical appearance: glandular type with increased sebum secretion, fibrous type with connective tissue overgrowth, fibroangiomatous type with edema and telangiectasia, and lastly actinic type with nodular masses of elastic tissue.3 Additionally, these phymatous features may extend beyond the nose, rarely affecting the chin (gnathophyma), forehead (metophyma), ears (otophyma), and eyes (blepharophyma).5
The history of surgical treatments for rhinophyma dates back to 1845, when Johann Friedrich Dieffenbach removed rhinophymatous tissue through vertical and horizontal incisions.2,6 In 1912, Wood removed rhinophymatous skin, followed by skin grafts, which resulted in poor results. Radiation therapy has also been used to decrease the number of sebaceous glands and atrophy of the pilosebaceous units. A study by Skala et al reported significant improvement in rhinophyma following 20 treatments of 40 Gy within one month.7 However, given the increased risk of malignancy with repeated radiation, this treatment modality has fallen out of favor.
Before treatment, a thorough examination is critical to confirm that nasal disfigurement is due to rhinophyma. There have been several reports of neoplasms mimicking rhinophyma, or a
