RHINOPHYMA - HEALTH

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Rhinophyma

Generality

Rhinophyma is a skin disease of the nose that arises secondary to a skin condition known as rosacea (or acne rosacea).

Those who suffer from rhinophyma have a nose with a strongly altered appearance: it is bulbous and irregular, takes on a color between red and purple, its skin is thickened, its surface becomes rough, its sebaceous glands dilate and its pores become they make very prominent and emit, incessantly, an anomalous oily secretion.
The precise causes of rhinophyma are unknown. The only certain fact is that the condition in question characterizes cases of rosacea at a severe or untreated stage.
The diagnosis of rhinophyma is very simple and is generally based on a quick physical examination and medical history.
The treatment of rhinophyma depends on the stage of advancement of the latter: in the presence of a rhinophyma at the beginning, doctors opt for drug therapy; in the presence of an advanced rhinophyma, however, they can only resort to surgery.

What is rhinophyma?

Rhinophyma is a skin disease that arises from advanced or untreated rosacea and causes a characteristic swelling and redness of the nose. Rhinophyma, therefore, is a nasal skin disease secondary to a severe and / or poorly treated condition of rosacea.

SYNONYMS

Rhinophyma is also known as "potato nose".
The term "potato nose" is somewhat ambiguous, as it is also used to define those noses which, due to natural somatic characteristics, have a rounded tip and marked wing cartilages.

EPIDEMIOLOGY

Rhinophyma is a rather rare condition, which is seen mainly in individuals with untreated rosacea or advanced rosacea.
Rhinophyma is more common in the male population.

Causes

Rhinophyma is certainly linked to the presence of rosacea; however, the precise pathological mechanisms by which the latter causes rhinophyma have always been a mystery.

SOME HYPOTHESES

Several doctors and pathologists have tried to study the causes of rhinophyma, developing some theories about it.
Among the various hypotheses formulated regarding the possible triggering factors for rhinophyma, two are worth mentioning:

The hypothesis according to which rhinophyma would depend on a dilation of the blood vessels, which has the effect of thickening the skin of the nose,

And

The hypothesis according to which rhinophyma derives from an instability of the nasal blood vessels, which determine, first, the abnormal loss of fluid in the surrounding tissues and, secondly, an inflammatory state and the formation of scar tissue.

ROSACEA: WHAT IS IT? A BRIEF REVIEW

Rosacea (or acne rosacea) is a chronic inflammatory skin disease that affects the face, especially its central part.
Despite numerous studies on the subject, the precise causes of rosacea are still in doubt. According to some of the most reliable theories, to cause the condition in question would be a fragility of the capillaries of the face, dependent on environmental factors and genetic factors. In other words, a mix of triggers would contribute to the onset of rosacea.
Rosacea most commonly affects people with fair complexions between the ages of 30 and 50. Several factors can aggravate it, including: emotional stress, cold or hot weather, ingestion of spicy or spicy foods, intense physical exertion, cosmetics, wind, alcohol consumption and cigarette smoking.
The typical symptoms and signs of rosacea consist of: redness of the face, the appearance of lesions or papules, telangiectasia, irritation and burning sensation in the eyes, and thickening of the skin.
Unfortunately, at the present time, there are no specific treatments for rosacea, but only non-specific treatments for the alleviation of symptoms (symptomatic therapy).

RINOFIMA AND ROSACEA

Rhinophyma distinguishes a particular type of rosacea, known as fimatous rosacea.
In addition to changing the appearance of the nose, fimatous rosacea can also alter the aesthetics of: chin (gnathophyma), ears (otophyma), eyelids (blepharophyma) and / or forehead (metophyma)

DOES IT DEPEND ON "ALCOHOLISM?

In the past, it was widely believed that rhinophyma was due to alcohol abuse (alcoholism).
Today, after in-depth and more than reliable studies, it is known that rhinophyma does not depend in any way on the abuse of alcoholic substances.

RISK FACTORS

Risk factors for rhinophyma are:

The male sex;
L "aged between 30 and 50 years;
The fair complexion;
Light colored hair;
Blue or green eyes;
A family history of rosacea.

Symptoms, signs and complications

Due to rhinophyma, the nose is subject to drastic changes:

It becomes bulbous and, in general, assumes an irregular shape;
His skin undergoes a noticeable thickening;
Its surface becomes rough;
It assumes a red-purplish color, due to the effect of telangiectasias and / or venulectases;
The pores of the skin become prominent and an unusual and large oily secretion comes out of them;
The sebaceous glands that cover the cartilage portions dilate (hypertrophy of the sebaceous glands).

Typically, rhinophyma affects the tip of the nose and the so-called nasal wings, i.e. the portions of the nose lateral to the tip.

Figure: Through this image, readers can appreciate the external anatomy of the nose and, in particular, the location of the nasal tip and the nasal wings.

DEGREES OF SEVERITY OF THE NAPHYM

Doctors classify the severity of rhinophyma into three degrees:

grade 1, which corresponds to the less severe rhinophyma,
grade 2, which is equivalent to rhinophyma of intermediate severity
grade 3, which corresponds to the most severe rhinophyma of all.

Grade 1 includes all cases of rhinophyma characterized by the excessive opening of the pores of the skin and the absence of skin thickening; Grade 2 includes all cases of rhinophyma characterized by the excessive opening of the pores of the skin and a moderate thickening of the nasal skin; finally, all cases of rhinophyma in which the excessive opening of the skin pores are associated with grade 3 skin thickening and hypertrophy of the sebaceous glands.

Summary table of the degrees of severity of rhinophyma Degree and severity Features Grade 1, the least severe

Oversized opening of the pores of the nasal skin.
Absence of skin thickening.

Grade 2, intermediate severity

Oversized opening of the nasal skin.
Moderate thickening of the skin of the nose.

Grade 3, the most severe

Oversized opening of the skin pores.
Hypertrophy of the sebaceous glands.
Moderate / severe skin thickening.

COMPLICATIONS

Without treatment, the changes that rhinophyma causes to damage the nose tend to get worse.
Advanced rhinophyma disfigures an individual's face in a marked and evident way. This can have psychological repercussions (eg: anxiety, etc.), linked to an aesthetic discomfort.
Rhinophyma is not a prelude to skin cancer.

Diagnosis

Being responsible for characteristic changes in the nose, rhinophyma is a condition that doctors diagnose very easily, through a simple observation of the nose (physical examination) and a medical history.
In the remote case in which there were doubts about the presence or absence of rhinophyma, the ideal diagnostic test to clarify the situation definitively is the biopsy of a portion of nasal skin.

Therapy

The treatment of rhinophyma depends on the stage of advancement of the latter. In fact, if the rhinophyma is in its infancy, a pharmacological therapy may suffice; while, if the rhinophyma is at an advanced-severe stage, it is essential to resort to treatments surgical type.

PHARMACOLOGICAL TREATMENT

Pharmacological treatment for rhinophyma, rather than cure the present condition, slows the progress of symptoms; it includes:

Oral antibiotics (eg: tetracycline, erythromycin or minocycline), to reduce any inflammation and redness;
Topical medicines (eg: metronidazole, tretinoin or azelaic acid), to reduce nasal swelling;
Particular capsules for oral use (eg: oral isotretinoin), to prevent the production of mucous secretions by the nasal sebaceous glands.

Remember that the aforementioned pharmacological preparations are also indicated for the treatment of rosacea.

SURGICAL TREATMENT

The purpose of the surgical treatment is to give the nose a normal or near normal appearance.
Through surgery, doctors can:

Eliminate the most evident nasal deformations;
Remove excess portions of skin;
Minimize telangiectasias and venulectasias;
Improve the aesthetics of the nose.

To succeed in the aforementioned intentions, there are various surgical techniques, including:

Traditional surgery, which involves the use of scalpels etc;
Dermabrasion, which consists in eliminating the most superficial layers of the skin (in this case the nasal skin) using a special tool;
Electrosurgery, which involves the use of electric current to destroy unwanted nasal tissue;
Cryosurgery, which relies on low temperatures to eliminate deformed nasal tissue and to be removed;
YAG laser therapy.

Prognosis

Currently available treatments for rhinophyma guarantee good results, so the prognosis tends to be favorable.
Clearly, as with so many other morbid conditions, the sooner diagnosis and therapy take place, the more likely they are to remedy the nasal disfigurements found in people with rhinophyma.