Rhinophyma is a skin disorder that causes the nose to become enlarged. Some other symptoms include lumpy, thickened skin and broken blood vessels.

The condition is much more common in males than females and usually develops between the ages of 50–70.

Researchers do not fully understand the cause, but they know that the precursor is acne rosacea, which involves inflammatory breakouts of pimples.

Once acne rosacea progresses to rhinophyma, the skin covering the nose increases in size and the tip of the nose expands. This characteristic appearance forms the basis of a diagnosis.

In the early stages, treatments involves medications, but in the advanced stages, it involves surgery. This is because affected tissue may obstruct the airways. The procedure smoothes or removes rough, thickened areas of skin and is safe and effective.

Keep reading to learn more about the causes, symptoms, diagnosis, and treatment of rhinophyma.

Rhinophyma involves an increase in sebaceous, or oil, glands and underlying connective tissues in the face. According to 2021 research, the exact cause is still unclear, and several factors may play a role. These include a combination of conditions that affect the immune system, nerves, and blood vessels.

The precursor to rhinophyma is acne rosacea, a long-term skin condition that is more common in females. A subset of people with acne rosacea later develops rhinophyma.

Rhinophyma occurs more often in males, at a ratio ranging from 5:1 to 30:1 and it typically develops in people aged 50–70. Due to the higher prevalence in males, scientists suspect that male hormones increase the risk.

Some people believe that alcohol consumption may lead to the condition, but studies do not support this link. However, alcohol and caffeine can both temporarily dilate blood vessels, which seems to worsen rhinophyma.

Evidence shows that rhinophyma begins as “pre-rosacea,” and the only symptom at this stage is facial flushing.

Later, this condition advances to vascular rosacea, which involves swollen blood vessels and redness. It later progresses to acne rosacea and causes inflammatory breakouts.

Finally acne rosacea advances to late stage rosacea, and rhinophyma is an aspect of this.

Excessive facial flushing is often the first symptom of rosacea. If it progresses to rhinophyma, a person may have:

  • thickened skin on the nose and elsewhere on the face
  • expansion of the tip of the nose
  • a bumpy texture on areas of the face
  • enlarged pores
  • oily skin

At this point, the condition may obstruct the airways. Also, chronic infection often results because the fluid from the sebaceous glands thickens and can hold bacteria.

Over time, the number of sebaceous glands and the changes in connective tissue increase, which can result in progressive deformity.

In addition, there is a link with cancer. Basal cell carcinoma occurs in 3–10% of people with rhinophyma, although the condition is benign at the beginning.

The characteristic appearance of rhinophyma often makes it easy to diagnose with a visual examination.

Doctors base their diagnosis on the presence of at least one primary feature and at least one secondary feature.

Primary features include:

  • blushing
  • persistent redness
  • pustules, small pimples containing pus
  • papules — small, solid pimples that are usually inflamed but do not produce pus
  • broken or dilated blood vessels near the skin’s surface

Secondary features include:

  • roughened patches of skin on the face
  • swelling
  • burning or stinging areas of the skin
  • eye symptoms, such as watery eyes or swelling of the eyelids
  • marked thickening of skin or excess tissue
  • these symptoms elsewhere on the body

Both nonsurgical and surgical treatments are available.

Nonsurgical treatments

Findings show that certain medications help. One option is topical metronidazole (Metrocream), a dug that reduces skin inflammation by inhibiting the generation of reactive oxygen species.

Another option is isotretinoin, a drug that shrinks the sebaceous glands, limiting how much oil they make. However, if a person wishes to have surgery, they must stop taking this medication.

Surgical treatment

Advanced rhinophyma requires surgery to remove affected tissue. A 2020 study describes the following safe, effective five-step surgical technique for rhinophyma:

  1. Dermabrasion: A motorized device resurfaces the skin to facilitate the next steps.
  2. Dermaplaning: This involves removing affected tissue without directly cutting it. It prepares the skin’s surface for the third step.
  3. Debulking: The surgeon uses curved scissors to cut away the thickened skin. They also take samples of any areas that may be malignant and send them to a lab for analysis.
  4. Electrocautery: This involves using heat to destroy the affected tissue.
  5. Laser use: This final step seals and micro-contours the wound.

Few long-term studies have explored how often rhinophyma recurs after surgery, though limited research suggests that this is possible.

In the early stages of rhinophyma, a person may experience excessive facial flushing. As the condition progresses, swollen blood vessels appear, then acne-like pimples.

Later, the nasal skin grows and the tip of the nose becomes larger. At this stage, doctors diagnose rhinophyma. It is benign initially, but it may block airways and increase the risk of skin cancer.

Surgical and drug-based treatments can help, but limited research suggests that the condition may recur after surgery.