Rhinophyma (enlarged nose)

Rhinophyma involves an increase in sebaceous, or oil, glands and underlying connective tissues in the face. While the exact cause is still unclear, 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.

Despite this, rhinophyma occurs more often in males. It also tend to develop in people aged 50–70. Due to the higher prevalence in males, scientists suspect that male hormones increase the risk.

Rhinophyma has historically been referred to as alcoholic nose due to the incorrect belief that alcohol consumption may lead to the condition. However, studies do not support this link. That said, alcohol and caffeine can both temporarily dilate blood vessels, which seems to worsen rhinophyma.

According to older research, cited in a 2023 article, 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. Although studies vary, it’s thought that basal cell carcinoma occurs in 15-30% of people with rhinophyma.

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
• 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 drug 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 the affected tissue. A 2020 study describes the following safe, effective five-step surgical technique for rhinophyma:

1. Dermabrasion: During this procedure, a motorized device resurfaces the skin to facilitate the next steps.
2. Dermaplaning: This involves removing affected tissue without directly cutting it. Dermaplaning 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.

What is rhinophyma caused by?

Scientists haven’t fully figured out exactly how rhinophyma develops. It seems to involve a mix of problems with how blood vessels and nerves work, along with how the immune system responds naturally in the body.

How can you get rid of rhinophyma?

Rhinophyma can be effectively treated with surgical techniques such as dermabrasion, electrocautery, and laser therapy.

These procedures aim to reshape and smooth the affected areas of the nose, improving both function and appearance.

What do the early stages of rhinophyma look like?

In the early stages, rhinophyma shares symptoms with rosacea, such as facial flushing or redness.

As rosacea advances, rhinophyma emerges with characteristic signs like an enlarged nasal tip and a bumpy or ridged texture on the face.

Is rhinophyma reversible?

No, rhinophyma is not reversible once it progresses to its hypertrophic and bulbous stages. At this point, surgical intervention is typically necessary to correct the deformity.

Rhinophyma may respond well to topical treatments, such as metronidazole and isotretinoin, in the early stages though.

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.