Rhinophyma is a cosmetically deformative condition with unmet needs — both in understanding etiology and in treatment options, says Deborah S. Sarnoff, M.D., clinical professor of dermatology, NYU Langone School of Medicine, New York, and director of dermatologic surgery, Cosmetique Dermatology, Laser & Plastic Surgery, New York.
“Rhinophyma is a very embarrassing and humiliating problem with enormous negative psychosocial implications resulting from its disfigurement and alleged association with alcohol use, and it can also have functional consequences, interfering with breathing, sleeping, eating, drinking and, even, vision,” Dr. Sarnoff says. “In recent years there have been some medical advances for masking and controlling the redness associated with rhinophyma, but surgery is still the only option for correcting the deformity. The field is wide open for researchers who are interested in developing new modalities for rhinophyma prevention and treatment,” she says.
EPIDEMIOLOGY AND ETIOLOGY
Rhinophyma is a subtype of rosacea characterized by thickened skin and enlargement of sebaceous glands, and there can also be prominent telangiectasias, venulectasias and pores. The pathology involves the skin, not cartilage or bone, and it most often affects the nose — usually the lower two-thirds. However, phymatous changes can also develop on the forehead, ears, chin and eyelids.
Although rosacea is much more common in women, men with rosacea are at greater risk to develop rhinophyma than their female counterparts. In addition, rhinophyma is seen more often in Caucasians than in other racial groups, and particularly in Caucasians with very fair skin.
“A reason for these differences is not known. They suggest there may be a hormonal or genetic component contributing to rhinophyma, and other theories propose Demodex mites, ultraviolet light exposure, heat, vitamin defficiency and alcohol or caffeine use may be causative or exacerbating factors,” Dr. Sarno says.