“Likely, the etiology is multifactorial,” she adds.
The phymatous changes are thought to result from unregulated superficial vasodilation and vascular instability, leading to lymph extravasation into surrounding tissues. Chronic edema from accumulating lymph incites an in ammatory reaction that results in fibrosis and sebaceous hyperplasia.
“In people who wear eyeglasses, pressure from the nose pads may particularly restrict lymph drainage and explain the localization of phymatous changes to the lower two-thirds of the nose,” Dr. Sarnoff observes.
Vascular-specific lasers or intense pulsed light treatment targeting blood vessels can be used to reduce redness and telangiectasias. Medical treatments that can help relieve redness include topical ivermectin, brimonidine and oxymetazoline as well as oral aspirin, clonidine and propranolol.
Surgery using physically destructive techniques, however, remains the only option for tissue contouring. Preferred approaches include the bloodless heated scalpel technique, radiofrequency ablation, electrosurgery and laser resurfacing using a carbon dioxide, erbium:YAG, or neodynium:YAG laser.