Treatment of Rhinophyma With Fractional CO2 Laser Resurfacing in a Woman of Color: Case Report and Review of the Literature

July 2021 | Volume 20 | Issue 7 | Case Reports | 772 | Copyright © July 2021


Published online June 23, 2021

Samuel S. Kassirer BAa, Robert H. Gotkin MDa, Deborah S. Sarnoff MDa,b

aCosmetique Dermatology, Laser & Plastic Surgery, LLP, New York, NY
bClinical Professor of Dermatology, Department of Dermatology, NYU Langone Health, New York, NY

Abstract
Rhinophyma is a disfiguring disorder that is characterized by an erythematous, hypertrophied, and inflamed lower two-thirds of the nose. Widely accepted as the severe form of acne rosacea, rhinophyma can result in functional, aesthetic, and psychosocial concerns that require treatment in a cosmetic fashion. Rosacea should be treated in its earliest manifestations to mitigate the progression towards rhinophyma; therefore, early detection and intervention is a crucial part of treatment. Little has been written on this subject in people of color. We present the first reported case of rhinophyma in a 62-year-old Fitzpatrick V female patient who was successfully treated with one session of fractional CO2 laser resurfacing. This case highlights the successful use of the fractional CO2 laser to treat rhinophyma in darker skin types (Fitzpatrick IV–VI) and underscores the potential for future use among patients of color.

J Drugs Dermatol. 2021;20(7):772-775. doi:10.36849/JDD.C702

INTRODUCTION

Rhinophyma, considered the culmination and most severe manifestation of acne rosacea, is a chronic, disfiguring dermatological disorder that may result in adverse psychological, functional, and cosmetic issues.1,2 The presentation of this phymatous subtype of rosacea is typically characterized by nodular hypertrophy of the alae and nasal tip, inflammation, telangiectasias, and erythema.3 Other forms of phymatous rosacea include gnathophyma, otophyma, blepharophyma, and metophyma.2 Although the pathogenesis is not fully understood, Demodex folliculorum, androgenic influence, vitamin deficiency, and vasodilator stimuli are thought to be contributing factors to the progression of rhinophyma.2,4-7 The pathologic process and the histopathology, however, are well described.8-10

Although acne rosacea is more prevalent among women (3:1), rhinophyma is more commonly found among men (20:1).1,2,11-13 Similarly, a significant discrepancy in the occurrence of rhinophyma exists between darker skin types (Fitzpatrick IV–VI) and lighter skin types (Fitzpatrick I–III), with reported cases among Fitzpatrick V–VI being exceptionally uncommon.2,10,14-16 We present a case of a 62-year-old Fitzpatrick V woman with a case of rhinophyma (Figure 1) who was successfully treated with fractional CO2 laser resurfacing of the nose. This rare case demonstrates the efficacy of fractional CO2 lasers to safely treat rhinophyma in patients of color, while improving their health, well-being, and cosmetic appearance.