Skin diseases of the nose

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Review

. 2016 May;30(3):83-90.

doi: 10.2500/ajra.2016.30.4318.

Ayse Pelin Yigider 
¹
, Fatma Tulin Kayhan, Ozgur Yigit, Ayse Kavak, Cemal Cingi

Affiliations

Affiliation

• ¹ Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey.

• PMID:

  27216341

• DOI:

  10.2500/ajra.2016.30.4318

Review

Ayse Pelin Yigider et al.

Am J Rhinol Allergy.

2016 May.

. 2016 May;30(3):83-90.

doi: 10. 2500/ajra.2016.30.4318.

Authors

Ayse Pelin Yigider 
¹
, Fatma Tulin Kayhan, Ozgur Yigit, Ayse Kavak, Cemal Cingi

Affiliation

• ¹ Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey.

• PMID:

  27216341

• DOI:

  10.2500/ajra.2016.30.4318

Abstract

Objectives:

The goal of this study was to review the main lesion types of the nasal skin and appropriate treatment strategies rather than to present a comprehensive list of all diseases that affect the skin that can involve the nose.

Methods:

We reviewed the main nasal skin lesion types and available treatment strategies. Nasal skin lesions were classified as benign, premalignant, or malignant.

Results:

Benign lesions of the nose include nonmalignant tumoral lesions (i.e., freckles, comedo, adenoma sebaceum [Pringle disease], hydrocystoma, fibrous papules, sebaceous hyperplasia, and rhinophyma), autoimmune and inflammatory conditions (i.e., pemphigus, sarcoidosis, systemic lupus erythematosus, facial eosinophilic granuloma, rosacea, herpes zoster infection, leishmaniasis, and leprosy), and vascular lesions (i.e., telangiectasis, hemangioma, and spider nevus). Premalignant lesions are actinic keratosis and keratoacanthoma; and malignant tumors are melanoma, basal cell carcinoma, and squamous cell carcinoma. Regardless of whether or not they are malignant, all facial lesions can yield significant cosmetic discomfort that should be evaluated carefully before commencing any curative or corrective intervention. In general, benign lesions are treated with dermabrasive modalities, such as trichloroacetic acid, phenol, salicylate, and laser ablation. Electrocautery, cryosurgery, and surgical excision are also used, although these methods may result in scar formation, which can sometimes be more problematic than the original lesion itself.

Conclusion:

Any disease that affects the skin, especially those diseases that are triggered by ultraviolet exposure, can involve the face and nose. Cosmetic defects due both to the lesion itself and the intervention must be discussed with the patient, preferably in the presence of a first-degree relative, before commencement of treatment. As a result of heterogeneity of skin lesions of the nose, appropriate education of general practitioners as well as otorhinolaryngologists is mandatory.

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Rhinophyma (nose): Causes, pictures, and treatment

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.

Rinofima. What is Rhinophyma?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Rhinophyma is a tumor-like benign change in the skin of the nose, which is manifested by hypertrophy of all elements of the nose, which disfigures a person’s face. Since all elements of the skin increase, the size and width of the ducts of the sebaceous glands are also hypertrophied. With rhinophyma, increased sebum secretion is noted, fat accumulates in the ducts, decomposes, resulting in an unpleasant odor. A simple dermatological examination is usually sufficient to make a diagnosis of rhinophyma. The results of a cytological examination of the discharge from the mouths of hypertrophied sebaceous glands allow to clarify the diagnosis.

ICD-10

L71.1 Rhinophyma

• Causes and mechanism of development of rhinophyma
• Clinical manifestations of rhinophyma
• Diagnostics
• Treatment of rhinophyma
• Prophylaxis
• Prices for treatment

General information

Rhinophyma is a tumor-like benign change in the skin of the nose, which is manifested by hypertrophy of all elements of the nose, which disfigures a person’s face. Since all elements of the skin increase, the size and width of the ducts of the sebaceous glands are also hypertrophied. With rhinophyma, increased sebum secretion is noted, fat accumulates in the ducts, decomposes, resulting in an unpleasant odor.

Causes and mechanism of development of rhinophyma

Rhinophyma is an infiltrative-productive complication of rosacea and is more often diagnosed in men over forty years of age. If there is no rosacea or rosacea in the anamnesis of a patient with rhinophyma, then it is considered as a separate disease. The etiology of the disease is not fully understood, but in people who are prone to frequent overheating and hypothermia, temperature fluctuations, such pathologies are diagnosed more often; high humidity or excessive dryness, as well as dusty air, also increase the risk of rhinophyma.

Patients with rhinophyma usually have a history of endocrine diseases, hormonal disorders, and diseases of the gastrointestinal tract. Hypovitaminosis, stressful situations and dietary errors are not in themselves the main cause of rhinophyma, but in combination with the above factors increase the likelihood of its occurrence.

There is no direct connection between rhinophyma and chronic alcoholism, but given that diseases of various organs and systems are associated with alcoholism, excessive drinking and rhinophyma are closely related. Congenital vascular changes in the skin of the face and transformation of the congenital vascular nevus in most patients lead to phim-like changes in the skin of the face.

Clinical manifestations of rhinophyma

Outwardly, rhinophyma looks like a growth, this occurs due to hypertrophy and hyperplasia of the nasal skin. The growth can be single or in the form of nodes, then nodular rhinophyma is diagnosed. Due to dilated vessels, the color of hypertrophied nodes can vary from red to dark brown and purple.

Large sebaceous glands and follicles are clogged with keratin, the area affected by rhinophyma is a lymphatic interfollicular inflammatory infiltrate. If the rhinophyma progresses, then granulomas are observed and often the giant sebaceous glands are emptied into the normal sinus. With rhinophyma, it is clearly seen that most of the hypertrophied tissue consists of dilated vessels with thin walls. Skin affected by rhinophyma is more susceptible to the development of neoplasms.

Rhinophyma occurs in several varieties:

Granular forms are diagnosed more often, growths of the skin of the nose in this case outwardly look like rough knots. The consistency of the nodes is soft, and the surface of the area affected by rhinophyma is glossy greasy with a bluish and less often purple tint.

The fibrous form of rhinophyma is less common, with this form the skin layers are also hypertrophied, but the skin is dense, which retains the configuration of the nose. The surface is smooth, shiny from enlarged pores, sebum may be released, which, when interacting with air, acquires an unpleasant odor. On palpation, pronounced hyperplasia of the sebaceous glands of various densities is felt.

Fibroangiomatous rhinophyma is clinically similar to the fibrous form of rhinophyma, but the nodes are more elastic and soft on palpation. Due to the large number of telangiectasias, the surface of the nose has a dark red color. This form of rhinophyma is differentiated from the rest by the presence of a large number of superficial and deep pustules. The content of the pustules is bloody-purulent, which shrinks into crusts as it is evacuated. Patients, in addition to shortness of breath, complain of itching, soreness and paresthesia.

The actinic form of rhinophyma has a more benign course, the layers of the dermis thicken evenly and slightly, the nose acquires a cyanotic color, telangiectasias are localized mainly on the wings of the nose. With this form of rhinophyma, there are no pustules, and the mouths of the sebaceous glands are slightly dilated, as a result of which sebum is separated moderately without the formation of crusts on the surface of the nose. The main pathogenetic component of actinic rhinophyma is actinic elastosis.

The course of rhinophyma is long, with a series of stages of remission of the process and stages of active growth. As a rule, active growth of rhinophyma is observed in the first years of the disease, after a few years the growth may completely stop, but the reverse development of rhinophyma is not observed. Rhinophyma makes nasal breathing difficult, and with a huge size and food intake, despite the fact that the pathological process does not affect the cartilage, the pressure from the overgrown rhinophyma on them is so great that the nasal cartilages are deformed or undergo complete destruction.

Diagnosis

The diagnosis of Rhinophyma is usually made by a dermatologist on the basis of a visual examination, the patient’s medical history and anamnesis. When pressed, a white pasty secretion is released from the deeply retracted mouths. The results of a cytological examination of the discharge make it possible to accurately diagnose, microscopy reveals a large number of epithelial cells, sebum, saprophytic microflora, pathogenic microflora may not always be present, the presence of demodex mites is also not always observed.

Despite the bright and specific clinical manifestations of rhinophyma, it must be differentiated from demodicosis, since rhinophyma can be complicated by demodicosis, but the latter is not the main pathogenetic mechanism; Cutaneous T-cell lymphomas, sarcaidosis, and lymphatic leukemias can also present as overgrowths of nasal skin tissue. Additional examinations, such as tissue biopsy, followed by histological analysis, help to exclude or confirm the diagnosis of “Rinophyma”.

Treatment of rhinophyma

Therapeutic methods of rhinophyma do not bring results, and therefore various methods of surgical treatment are used. Dermabrasion of the skin area affected by rhinophyma gives good results with minor tissue growths and in the initial periods of the disease. Subcutaneous excision of overgrown tissues and wedge-shaped excision of areas affected by rhinophyma with intradermal sutures are indicated for deep lesions of the nasal skin and when it is impossible to use other methods of surgical treatment of rhinophyma.

Laser therapy for rhinophyma during treatment allows modeling disfigured forms of the nose, that is, therapeutic and aesthetic effects are achieved. If a small area is affected by rhinophyma, then laser removal of the overgrown dermis is indicated. The process of epithelialization occurs 7-10 days after the procedure. The radio wave method in the treatment of rhinophyma allows you to quickly and effectively eliminate all clinical manifestations and restore the shape of the nose. With this treatment, there is practically no blood loss, no swelling, the likelihood of postoperative complications is minimal, and the rehabilitation process is short.

Sometimes, with layer-by-layer excisions of rhinophyma, patients require rhinoplasty to restore its shape and achieve an aesthetic appearance. But the main point in therapy is the partial removal of outwardly unchanged tissues in order to reduce the likelihood of recurrence of rhinophyma. With a properly performed operation, relapses occur in only a few percent of patients.

Prevention

There is no specific prevention of rhinophyma, but timely treatment of rosacea and rosacea reduces the risk of rhinophyma. After surgical treatment of rhinophyma, patients should avoid sudden changes in temperature, review their diet and, if necessary, change jobs.

You can share your medical history, what helped you in the treatment of rhinophyma.

Sources

1. self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Rinofima

   To the guide

   Rhinophyma is a hypertrophic neoplasm on the skin of the external nose, provoked by chronic inflammation of the sebaceous glands.

   Article rating

   5.00 (Voted: 2)

   Rhinophyma is a hypertrophic formation on the skin of the external nose, which has developed as a result of chronic inflammation of the sebaceous glands against the background of disorders of the endocrine and digestive systems.

   Causes of rhinophyma

   Factors causing disease:

   • alcohol abuse;
   • high content of spices in food;
   • systematic effects of low or high temperatures on the tissues of the nose;
   • immunosuppression;
   • pathology of the gastrointestinal tract.

   Sometimes the pathological process is supported by demodex folliculorum mite inhabiting the sebaceous glands.

   Clinical picture

   At the initial stage, the skin of the nose is covered with nodules of a reddish hue. Subcutaneous vessels in the cartilaginous region become visible to the naked eye. The growth of these nodules leads to tissue hypertrophy, which now affects not only the sebaceous glands, but also the blood and lymphatic vessels.

   This results in a kind of growth on the skin. Its surface is covered with tubercles, usually in the amount of three (in front and on the sides). The color of the nodules changes from red to blue-purple. On average, the diameter of such neoplasms is from 5 to 8 centimeters. Pain is absent.

   Rhinophyma is more typical for men, occurs in old age. Timely treatment is required to avoid malignancy.

   Diagnosis

   Diagnosis of the disease, taking into account the characteristic clinical signs, does not cause difficulties. According to the results of histological examination, growths in the connective tissue are revealed, the number of sebaceous glands is increased, the walls of the vessels around which inflammatory elements are concentrated are thickened.

   Treatment of rhinophyma

   Treatment is complex and depends on the stage of development of the disease. At the stage of single pink nodules, the essence of therapy is to restore microcirculation in the skin. The main attention is paid to the correction of disorders in the digestive system.

   Medicines are prescribed to improve digestion, for example, “Hilak forte”, “Bifidumbacterin” and others. Inflammation is controlled by local treatment of the integument with metronidazole ointment, the application of boron and other lotions, as well as by the use of metronidazole and alternative antimicrobials.

   In the stage of rhinophyma, treatment is only surgical. Surgical removal of hyperemic skin areas is performed under local or general anesthesia. At the same time, the aesthetic shape of the nose is recreated. The postoperative wound is closed with a vaseline bandage. As new, healthy tissue forms, scarring does not form.

   Prevention

   The basis of disease prevention is: a favorable general regimen, dosed exposure to ultraviolet light, the exclusion or minimization of sudden temperature fluctuations and prolonged hypothermia. It is important to follow a diet that prescribes to limit the consumption of alcohol, coffee, smoked meats and foods high in spices.