Phymatous rosacea is an inflammatory skin condition of the face that affects males more often than females. While it typically appears on the nose, it may also affect the forehead, chin, and ears. Symptoms include thickening of the skin with irregular surface nodules and enlarged pores.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Was this helpful?

Doctors do not fully know the cause, but factors such as genetics, malfunctioning of the immune system, and exposure to ultraviolet (UV) light may play a role.

Doctors can diagnose the condition after reviewing a person’s symptoms. Treatment includes medications for inflammation and surgical procedures to remove or reduce growths.

This article explains phymatous rosacea, including symptoms, causes, treatment, diagnosis, outlook, prevention, and when to call a doctor.

person touching their faceShare on Pinterest
Maskot/Getty Images

Phymatous rosacea is one of the four subtypes of rosacea, a common, long-term inflammatory skin condition that involves relapses, notes research. It affects males more frequently than females.

In this condition, oil glands in the face enlarge, and hair follicles dilate or widen. It usually occurs in adulthood, but it can affect children in rare cases. Without medical intervention, the condition may result in irreversible skin changes.

Learn more about rosacea.

Manifestations of phymatous rosacea include thickening skin with irregular surface nodules, small areas of swelling, and accumulations of cells. Enlarged pores accompany the thickened skin.

Evidence indicates that the symptoms most commonly affect the nose, in which case, the medical term for the condition is “rhinophyma rosacea.” When this happens, the nose appears bumpy and larger than typical. The skin changes may also affect the forehead, chin, and ears.

Phymatous rosacea is usually a late manifestation of rosacea, which means a person has already experienced the general symptoms common to all types, such as recurrent facial blisters. However, some people present with phymatous rosacea without having any previous skin condition.

Learn more about the different types of rosacea.

Once a person experiences rosacea symptoms — such as discoloration and other atypical skin manifestations — they should make an appointment with a dermatologist. This professional can monitor the condition, advise treatment, and provide a skin care plan with specific product recommendations.

Researchers do not fully understand the exact cause, but factors that may play a role include:

  • genetics
  • environmental agents
  • atypical functioning of the immune system
  • microorganisms
  • atypical changes in the nerves and blood vessels
  • exposure to ultraviolet light

Treatment involves medication and nonmedication options.

Medications for inflammation may include a tetracycline such as doxycycline (Adoxa, Doryx, Oracea). They may also include isotretinoin (Accutane, Absorica, Claravis). Doxycycline is an antibiotic, and isotretinoin is a derivative of vitamin A.

Treatment for growths may include:

  • CO2 laser, which removes the top layers of the skin
  • surgical removal, which involves the use of a scalpel to remove tissue
  • electrosurgery, which involves the use of an electric current to destroy or cut away tissue

Some type of surgical intervention is necessary to remove irreversible skin changes. The goals involve sculpting the affected area and reducing the bulk of excess tissue. According to research findings, laser or electrosurgery can reshape and contour enlarged tissue. Lasers offer the advantage of producing less bleeding than surgery with a scalpel.

In addition to treatment, people may use a foundation or skin concealer to cover skin changes, but they should ask their dermatologist to recommend specific products. Those with a greenish hue can help balance the discoloration. However, doctors do not advise using greasy or oily products, as they irritate the skin because they are more difficult to remove.

Learn more about laser for rosacea.

Doctors base a diagnosis on the symptoms they note during a physical examination. The diagnostic process also includes a history, where they may ask a person about possible triggers. No lab tests or imaging procedures are necessary.

Rosacea is not life threatening, and the general outlook for people with the condition is good. That said, permanent discoloration and scarring can occur.

The physical changes in the skin may lead to psychological conditions, including depression and anxiety.

The American Academy of Dermatology offers the following tips to prevent flare-ups from all subtypes of rosacea:

  • Protect skin from the sun: This includes:
    • seeking shade and avoiding the midday sun
    • wearing a wide-brimmed hat when outdoors
    • applying a gentle, fragrance-free sunscreen with an SPF of at least 30
  • Avoid overheating: This includes:
    • taking warm rather than hot showers
    • keeping cool with a fan or air-conditioning
    • sitting at a distance from heaters and other sources of heat
  • Decrease stress: This includes:
    • finding something that lowers stress, such as joining a rosacea support group
    • when stressed, taking a deep breath, holding it, and then releasing it slowly
    • doing something enjoyable each day
  • Avoid hot beverages: A person can let a beverage cool to lukewarm before drinking it.
  • Limit food spiciness: For example, someone can pick a mild version instead of hot salsa.
  • Watch alcohol intake: This may include:
    • switching from red to white wine
    • limiting intake to one or two drinks and following consumption with a large glass of cold water
    • adding soda to alcoholic beverages to dilute them
  • Select skin care products carefully: This includes avoiding toners and astringents, as well as products that contain camphor, menthol, and sodium lauryl sulfate.

Phymatous rosacea is a subtype of the inflammatory skin condition of the face called rosacea. It causes oil glands to enlarge and hair follicles to dilate. The condition most commonly affects the nose and manifests with thickened skin and irregular surface nodules.

The cause is not fully known, but genetics and an array of other factors may have an influence.

Doctors base a diagnosis solely on symptoms. Treatment of inflammation may include doxycycline or isotretinoin, while treatment of growths may necessitate some form of surgery.

The outlook is generally good, but a person may experience psychological effects. To prevent flare-ups, experts recommend measures such as staying cool and avoiding heat sources.

If someone has symptoms, it is best to consult a dermatologist early, before the skin changes become irreversible and require surgery.