rinofima

Rhinophyma is a form of phymatous rosacea characterized by progressive hypertrophy of the nasal skin and underlying soft tissues, leading to a bulbous, rough, and sometimes nodular nose. It most often develops in individuals with long-standing rosacea and tends to become noticeable in middle to older age.

The exact cause is not fully understood, but rhinophyma is considered part of the spectrum of rosacea. Chronic inflammation, sebaceous gland hyperplasia, fibrosis of the dermis, and vascular changes contribute to tissue overgrowth. Other factors that may worsen the condition include sun exposure, hot or spicy foods, alcohol use, and Demodex mite colonization. It is not caused by alcohol consumption, despite a common myth.

Clinically, rhinophyma presents as gradual enlargement of the nose with thickened, oily, or waxy skin, prominent pores, and irregular surface contour. The nasal tip and alae may become enlarged, and vascular changes can cause telangiectasias. In severe cases, nasal obstruction may occur due to tissue overgrowth.

Diagnosis is usually clinical, based on appearance and history of rosacea. Biopsy is rarely needed unless there is concern for alternative diagnoses or malignancy.

Treatment aims to control rosacea activity and correct the nasal deformity. Medical therapy includes topical agents (metronidazole, azelaic acid) and oral antibiotics (doxycycline), used to manage inflammation. Isotretinoin may be considered in selected severe cases. For established rhinophyma, surgical options such as CO2 laser, Er:YAG laser, dermabrasion, electrosurgery, or scalpel-based debulking are employed to reshape the nose. Recurrence can occur, requiring repeat procedures and ongoing rosacea management.