Many do not recognize the term “rhinophyma”, but they’ll know it when they see it. Whether they call it a “bulbous nose”, “whisky nose”, or “witch’s nose”, the theme is clear--this isn’t something anyone wants to have.
Unfortunately, there is a small subset of people who have phymatous rosacea. It’s not an easy condition to live with, what with the widespread notion that it is caused by alcoholism, and the premium society puts on clear, smooth, even-toned skin.
Awareness is the first step to ending discrimination. Let’s discuss what phymatous rosacea is, what causes it, and how it can be managed.
What is phymatous rosacea
Coming from the Greek word for “growth”, phymatous rosacea is characterized by thick, red, pitted skin that bulges outwards in nodules. “Rhinophyma” translates to “nose growth”, which is the most common presentation of this condition. However, it can also affect the chin, cheeks, forehead, and ears.
Though most forms of rosacea affect women more often than men, phymatous rosacea is the opposite. Studies estimate that the ratio of males to females with this condition is anywhere from 12:1 to 30:1. Males in their 50s to 70s comprise the bulk of phymatous rosacea patients. The impact to their psychosocial wellbeing cannot be discounted.
What causes phymatous rosacea
Science has yet to uncover what causes rosacea, regardless of its form. It is likely a mix of genetic, inflammatory, vascular, and environmental factors. While the cause of phymatous rosacea is likewise shrouded in mystery, researchers have plausible guesses about how it comes about.
The pathophysiology likely involves chronic inflammation and vasodilation in facial skin. The immune system is always triggered, mounting a response inappropriate to the perceived threat. As such, the process ends up damaging the patient’s own skin cells. When things quiet down, the body heals itself through fibrosis and replaces the destroyed cells with new ones--this include both dermal cells and the sebum-producing cells.
This process cycles over and over again, until the layers of fibers and new skin cells pile on top of each other, creating the nodules and bumps characteristic of this condition. In severe cases of rhinophyma, the tissue growth impedes airflow through the nostrils.
How is phymatous rosacea treated
Unlike less advanced stages of rosacea, rhinophyma cannot be treated topically. Orally administered drugs are much more effective. The antibiotic doxycycline appears to have anti-inflammatory properties that significantly help improve the appearance of phymatous rosacea. Isotretinoin, a drug used in severe cases of acne, also has a dramatic effect on the skin of rhinophyma patients. However, the results of oral medications take time to develop. It will take months of consistent use to see the change.
Because of this, surgery remains the top option for improvement of phymatous rosacea. The process removes the abnormal growths while keeping the original shape of the nose. Laser therapy is another option that is fast gaining popularity.
Note that these techniques have some risk of recurrence. Consult your doctor which one is best for you.
Conclusion
Rhinophyma and its cousins represent the most severe version of rosacea. People who suffer from this condition are plagued by stigma, feelings of low self-esteem, and social anxiety. The best way to relieve this is to seek treatment for the removal of growing tissues, follow the management protocol for other forms of rosacea, and find a strong support group either with family, friends, or relevant support groups and therapists.
This content is for general information only and is not a substitute for medical advice.
Resources:
Laun, J., Gopman, J., Elston, J. B., & Harrington, M. A. (2015). Rhinophyma. Eplasty, 15, ic25.
Chauhan R, Loewenstein SN, Hassanein AH. Rhinophyma: Prevalence, Severity, Impact and Management. Clin Cosmet Investig Dermatol. 2020;13:537-551
https://doi.org/10.2147/CCID.S201290
