What are the other Names for this Condition? (Also known as/Synonyms)

• Potato Nose

What is Rhinophyma? (Definition/Background Information)

• Rosacea is a common, chronic skin disorder that manifests as reddish skin with papules and pustules on the face. It occurs due to inflammation of the sweat glands and hair follicles
• Rhinophyma is a special type of rosacea affecting the nose. In this condition, even though the skin lesions are present around the face, they are very prominent on the nose. It can result in thickened skin around the nose, giving it a red, puffy appearance
• Rhinophyma is typically observed in elderly adults. Also, it is much more common in men; women are rarely affected
• The cause of Rhinophyma is generally unknown, but it may be more commonly seen in patients with significant acne during adolescence. The condition can also be aggravated by a variety of factors, most importantly alcohol consumption
• Since Rhinophyma is a longstanding condition with exacerbation and remission of symptoms over a long period, it can result in emotional stress and trauma in some individuals
• Currently, no treatment measures are available for Rhinophyma that can ensure its cure. However, a lack of treatment can make the condition much worse
• A symptomatic management of the condition and avoidance of the aggravating factors is practiced. The prognosis for Rhinophyma is good with suitable treatment; however, the skin condition can recur

Who gets Rhinophyma? (Age and Sex Distribution)

• Rhinophyma is a common, benign skin condition that may affect individuals of any age. However, it is generally seen in adults in the 50-70 years age range
• Even though both males and females are affected, Rhinophyma is rarely observed in females. Some studies show the male-female ratio as 12:1
• Individuals of all racial and ethnic background may be affected. But it is more common in fair-skinned individuals than dark-skinned individuals
• Worldwide, no geographical localization has been reported for this skin condition; nevertheless, it is more frequent among the north Europeans

What are the Risk Factors for Rhinophyma? (Predisposing Factors)

The following risk factors have been identified for Rhinophyma:

• Acne during adolescence
• Fair-skinned Caucasians (Europeans, Americans) have a greater risk over Africans and Asians (who are generally darker-skinned)

Factors that increase the severity of the skin findings may include:

• Increased alcohol consumption
• Sun exposure without adequate cover or sun protection
• Exposure to heat such as while working in the kitchen or a factory
• Spicy foods
• Consumption of hot fluids (the condition may become worse around the mouth)
• Feeling stressed out also causes flare ups

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Rhinophyma? (Etiology)

Currently, the cause of development of Rhinophyma is unknown.

What are the Signs and Symptoms of Rhinophyma?

Rhinophyma leads to chronic inflammation of the facial oil glands and hair mainly around the nose and adjoining areas. The symptoms get better and worse over time. The majority of individuals have mild signs and symptoms. In general, the signs and symptoms of Rhinophyma may include the following:

• Formation of multiple papules and pustules
• Over a long period of time, it can result in hypertrophied sebaceous (oil) glands on and around the nose
• The nose appears large and bulged; it can be termed as disfigured or ‘out of shape’
• Flushing of face (redness, like blushing)
• Other areas on the face, head and neck region can also be affected

How is Rhinophyma Diagnosed?

There is no single test available to definitively diagnose Rhinophyma. A diagnosis of Rhinophyma may involve the following tests and procedures:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Bacterial culture to rule out any bacterial infection
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist may arrive at a diagnosis.

Based on the pathological studies and findings under a microscope, Rhinophyma can be classified into the following types:

• Glandular type of Rhinophyma
• Fibrous type of Rhinophyma
• Fibroangiomatous type of Rhinophyma

A differential diagnosis for Rhinophyma may be undertaken to eliminate the following conditions:

• Acne
• Perioral dermatitis
• Bacterial infection
• Lupus (SLE)
• Seborrheic dermatitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Rhinophyma?

Rhinophyma is a chronic and longstanding skin condition. It can result in the following complications:

• Secondary bacterial or fungal infections due to ulceration and bleeding of the lesions
• Scarring and permanent disfigurement of the nose
• The presence of skin infections and scarred skin on the nose and face can cause self-image issues (cosmetic concerns), severe emotional stress
• The thickening of nasal tissues can obstruct nasal breathing
• Severe stress from chronic Rhinophyma can lead to depression
• The skin condition may inadvertently get aggravated by a host of common factors, which include anxiety, alcohol, certain foods, drinks containing caffeine, and heavy exercising
• Recurrence of the condition, even after the signs and symptoms have completely disappeared

How is Rhinophyma Treated?

Currently, there is no established cure for Rhinophyma. The treatment depends upon the severity of the condition. It may involve the following measures:

• Topical creams and antibiotics
• Oral medications such as antibiotics
• Using laser surgery or electrosurgery to remove the hypertrophied tissues and reshape the nose
• Protect skin from sun; use of sunscreens, wide-brimmed hats, protective clothing
• Follow-up care with regular screening and checkups are important

Note: Topical applications and oral medications containing steroids are known to make the condition worse.

How can Rhinophyma be Prevented?

Currently, there are no known methods available to prevent the occurrence of Rhinophyma. However, controlling or avoiding the following factors may help prevent it from getting worse (i.e., prevention of flare ups):

• Reducing or eliminating alcohol consumption is the most important preventative factor
• Vigorous exercise
• Stress and anxiety
• Caffeinated drinks
• Use of topical or oral steroids, nasal steroid sprays
• Foods containing high levels of histamines such as pickled foods, canned foods, certain cheese varieties, smoked meat, shellfish, beans and pulses, including certain nuts (cashew, almonds)
• Avoidance of spicy foods and hot liquids
• Sometimes, cosmetic procedures, such as chemical peels and microdermabrasion, make Rhinophyma worse. These procedures are often used to treat wrinkles and acne
• Avoid prolonged and chronic exposure to the sun
• Avoid excessive sunbathing, use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
• Avoid exposure to excess heat, such as in a home or industrial setting

Note: Keeping a journal as to what triggers the condition may help in avoiding such factors, into the future.

What is the Prognosis of Rhinophyma? (Outcomes/Resolutions)

• The prognosis for Rhinophyma is good with appropriate treatment
• However, the condition recurs even after complete resolution following treatment. Many researchers believe that it is a lifelong condition
• In some cases, the signs and symptoms disappear even without treatment

Additional and Relevant Useful Information for Rhinophyma:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse