What are the aims of this leaflet?

This leaflet has been written to help you understand more about rhinophyma. It tells you what rhinophyma is, what causes it, what can be done about it, and where you can find out more about it.

What is rhinophyma?

Rhinophyma is a swelling of the nose. If the condition progresses, the nose becomes redder, swollen at the end and gains a bumpy surface which changes its shape. This swelling is because there is formation of scar-like tissue and the sebaceous glands (which produce oil on the skin) get bigger. Much more rarely, swellings can arise on other parts of their face such as the ears and chin.

The condition is mainly seen in those who have rosacea, a rash that can affect the cheeks, forehead and nose (see rosacea leaflet for further information). Rhinophyma usually only develops in rosacea which has been active for many years. However, although rosacea affects woman more than men, rhinophyma is seen mainly in fair-skinned men aged 50 to 70 years.

What causes rhinophyma?

The causes of rhinophyma are not fully understood. Rhinophyma can occur as a more severe stage of rosacea. However, some people have rhinophyma without having rosacea.

Although commonly believed to be due to alcohol, there is no link between rhinophyma and excessive drinking.

Is rhinophyma hereditary?

There is no clear genetic link.

What does rhinophyma look like?

Initially there may just be redness of the nose and a few small bumps. Over time however the nose becomes more swollen and bulbous.  The growth can become quite large with prominence of the skin pores.

How is rhinophyma diagnosed?

The diagnosis is usually made based on the site involved and appearance of the skin. If the diagnosis is unclear a dermatologist may take a small skin biopsy under local anaestheticfor examination under the microscope.

Can rhinophyma be cured?

Although there is no cure for rhinophyma, treatments can be effective in controlling it.

How can rhinophyma be treated?

Rosacea can be helped a little with topical treatments such as creams and gels, as well as by courses of antibiotics lasting several months. Another option is oral isotretinoin, a tablet also used for acne.

However, these treatments do not usually work very well in rhinophyma, and surgery is often necessary. The aims of surgical treatments are to remove the excess tissue and restore the natural shape of the nose. Additional treatments can reduce the redness of the nose. Depending on the severity and extent of the rhinophyma a doctor may offer some of the following treatments:

• Dermabrasion – a device which uses a wire brush or a burr (a wheel with rough edges) which rotates rapidly and removes the upper layers of the skin. This effect can also be achieved with lasers.
• Electrosurgery and Electrocautery – this treatment uses devices that deliver high frequency electrical currents that heat up and help remove excess tissue.
• Scalpel or razor blade excision – this involves using either a scalpel or razor blade in a controlled manner to help remove the excess tissue.

These treatments can be performed either by dermatologists, plastic surgeons or ear nose and throat surgeons. There are advantages and disadvantages with all of the above treatments which your specialist will go through with you. Sometimes more than one attempt or a combination of different treatments is required to obtain a good outcome.

It is important to note that these treatments do not cure rhinophyma; they aim to remove overgrowth of excess tissue and reshape the nose. Recurrence of the problem can occur which may then require further treatments.

Self care (What can I do?)

• Protect your skin from the sun by using a sun block (with a sun protection factor of at least 30) on your face every day.
• Use a soap substitute to cleanse your face such as a gentle moisturiser.
• Use an un-perfumed moisturiser on a regular basis if your skin is dry or sensitive.
• Camouflage products can often cover up redness effectively, and some patients may benefit from the use of skin camouflage to cover redness. A health care professional will be able to help you find a local service if necessary. Camouflage can be very effective in altering the skin colour, but they cannot alter the shape or texture of the skin.

You can take some simple precautions to protect your skin by following the below ‘top sun safety tips’:

• Protect your skin with clothing, and wear a broad-brimmed hat that protects your face, neck and ears, and a pair of UV protective sunglasses.
• Stay in the shade between 11am and 3pm when it is sunny. Step out of the sun before your skin has a chance to redden or burn.
• When choosing a sunscreen look for a high protection SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun. Reapply every two hours and straight after swimming and towel-drying.
• Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
• Remember that winter sun, such as on a skiing holiday, can contain just as much of the damaging ultra-violet light as summer sun.
• Do not use sunbeds or sunlamps.
• Consider purchasing UV protective swim and beach wear which can particularly assist in protecting the trunk when swimming on holiday.
• It may be worth taking Vitamin D supplement tablets (available from health food stores) as strictly avoiding sunlight can reduce Vitamin D levels. If you are having a kidney transplant, discuss this first with your kidney specialist.

Where can I get more information?

Web links to further information:

http://www.patient.co.uk/doctor/Rosacea-and-Rhinophyma.htm
http://www.dermnetnz.org/acne/rosacea.html

Jargon Buster: https://www.skinhealthinfo.org.uk/support-resources/jargon-buster/

Please note that the BAD provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET
PRODUCED OCTOBER 2014
NEXT REVIEW DATE OCTOBER 2017