Rhinophyma is a condition causing development of a large, bulbous

nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...

associated with

granuloma A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such sub ...

tous infiltration, commonly due to untreated

rosacea Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, en ...

. The condition is most common in older white males. Colloquial terms for the rhinophyma include "whiskey nose", "gin blossom", "toros nose", and "potato nose".

Signs and symptoms

Rhinophyma is characterised by prominent pores and a

fibrous Fiber (spelled fibre in British English; from ) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often inco ...

thickening of the nose, sometimes with

papule A papule is a small, well-defined bump in the skin lesion, skin. It may have a rounded, pointed or flat top, and may have a umbilication, dip. It can appear with a Peduncle (anatomy), stalk, be thread-like or look warty. It can be soft or firm a ...

s. It is associated with the common skin condition

and it can be classified clinically into 5 grades of increasing severity.

Complications

Tissue thickening may come to cause airway obstruction and impede breathing. Rhinophyma can cause psychological distress due to its effect on one's personal appearance, as well as social perception of a link with alcoholism.

Causes

Rhinophyma develops in certain individuals with an unknown predisposition from long-standing

which has progressed to a severe form. Although rhinophyma has been commonly presumed to be linked to alcoholism, a direct causal relationship between the condition and excessive alcohol consumption has not been substantiated.

Alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

may cause increased flushing in those affected.

Pathophysiology

Rhinophyma develops in some individuals after long-standing rosacea that has progressed to acne rosacea. Rosacea usually commences in people between the age of 20–30 years. Rosacea begins with facial flushing (pre-rosacea). The nasal skin then thickens and hypervascularises, leading to persistent erythema (vascular rosacea). Papules and pustules then develop, marking the beginning of acne (inflammatory) rosacea. A subset of those affected by acne rosacea go on to develop rhinophyma. Chronic infection is common as the thickened sebaceous fluid traps bacteria. Rhinophyma is characterised by hypertrophy of nasal skin, with

hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of Tissue (biology), organic tissue that results from ...

and

fibrosis Fibrosis, also known as fibrotic scarring, is the development of fibrous connective tissue in response to an injury. Fibrosis can be a normal connective tissue deposition or excessive tissue deposition caused by a disease. Repeated injuries, ch ...

of the

sebaceous gland A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in ...

s and connective tissue. The nasal tip and alae are preferentially affected by the

hypertrophy Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number. Although hypertro ...

, and the lower portion of the nose is predominantly affected. The underlying bony structure is not affected. The exact pathophysiological mechanism underlying the development of rosacea and rhinophyma is unknown, but a combination of neurovascular and immune disturbance is thought to be involved, causing inflammation, fibrosis, and vascularisation.

Male predisposition

Even though females are more often affected by acne rosacea, they seldom go on to develop rhinophyma. It is thought that androgenic factors predispose men to develop rhinophyma.

Diagnosis

Rhinophyma is diagnosed and graded clinically based on presentation. Diagnosis confirmation by pathology is highly recommended due to potential for differential diagnosis and ability of rhinophyma to hide underlying cancers. Pathology confirmation is especially important in areas endemic with leishmaniasis.

Treatment

Treatment consists of paring down the bulk of the tissue with a sharp instrument or

carbon dioxide laser The carbon-dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed. It was invented by C. Kumar N. Patel, Kumar Patel of Bell Labs in 1964 and is still one of the most useful types of laser. Carbon dioxide, Carbon-dioxide lase ...

and allowing the area to re- epithelialise. Sometimes, the tissue is completely excised and the raw area skin-grafted.

Epidemiology

Rhinophyma is most common in males of European heritage over the age of 50. Males are 5 to 30 times as likely to be affected as females, possibly due to androgenic factors. In the United States, people of predominantly Asian and African ancestry are only rarely affected by the condition.

Society

Colloquial names for the condition include "whiskey nose", "gin blossom", and "potato nose". The condition has often been presumed to be a result of alcoholism (even though it remains unclear whether alcohol actually contributes to the development of rhinophyma) which has led to stigmatisation of people with the condition. In film, villainous characters have been portrayed as having rhinophyma, notably the evil queen (when disguised as a witch) in the animated film ''

Snow White and the Seven Dwarfs "Snow White" is a German fairy tale, first written down in the early 19th century. The Brothers Grimm published it in 1812 in the first edition of their collection ''Grimms' Fairy Tales'', numbered as Tale 53. The original title was ''Sneewittch ...

''. Among those known to have had the disease before modern treatment were the American banker

J. P. Morgan John Pierpont Morgan Sr. (April 17, 1837 – March 31, 1913) was an American financier and investment banker who dominated corporate finance on Wall Street throughout the Gilded Age and Progressive Era. As the head of the banking firm that ...

and the American comedian W. C. Fields.Kennedy, David M., and Lizabeth Cohen; ''The American Pageant''; Houghton Mifflin Company: Boston, 2006. p. 541.

References

External links

{{Disorders of skin appendages Acneiform eruptions Nose disorders