Rhinophyma is a tumor–like benign change in the skin of the nose, which is manifested by hypertrophy of all elements of the nose, which disfigures a person’s face. Since all the elements of the skin increase, the size and width of the ducts of the sebaceous glands are also hypertrophied. With rhinophyme, increased sebum secretion is noted, fat accumulates in the ducts, decomposes, resulting in an unpleasant odor. A simple dermatological examination is usually enough to diagnose rhinophyma. To clarify the diagnosis, the results of cytological examination of the separated mouths of hypertrophied sebaceous glands allow.
ICD 10
L71.1 Rhinophyma
General information
Rhinophyma is a tumor–like benign change in the skin of the nose, which is manifested by hypertrophy of all elements of the nose, which disfigures a person’s face. Since all the elements of the skin increase, the size and width of the ducts of the sebaceous glands are also hypertrophied. With rhinophyme, increased sebum secretion is noted, fat accumulates in the ducts, decomposes, resulting in an unpleasant odor.
Causes
Rhinophyma is an infiltrative-productive complication of rosacea and is more often diagnosed in men over forty years of age. If there is no rosacea or pink acne in the anamnesis of a rhinophyma patient, then it is considered as a separate disease. The etiology of the disease has not been fully studied, but in people who are prone to frequent overheating and hypothermia, temperature fluctuations, such pathologies are diagnosed more often; increased humidity or excessive dryness, as well as dustiness of the air also increase the risk of rhinophyma.
Patients with rhinophyma usually have a history of endocrine diseases, hormonal disorders, diseases of the gastrointestinal tract. Hypovitaminosis, stressful situations and errors in the diet themselves are not the main cause of rhinophyma, but in combination with the above factors increase the likelihood of its occurrence.
There is no direct connection between rhinophyma and chronic alcoholism, but considering that diseases of various organs and systems are associated with alcoholism, excessive consumption of alcoholic beverages and rhinophyma are closely related. Congenital vascular changes in the skin of the face and the transformation of congenital vascular nevus in most patients lead to phim-like changes in the skin of the face.
Symptoms
Externally, the rhinophyme looks like an outgrowth, this is due to hypertrophy and hyperplasia of the nasal skin. The growth may be single or in the form of nodes, then a nodular rhinophyma is diagnosed. Due to dilated vessels, the color of hypertrophied nodes can vary from red to dark brown and purple shades.
Large sebaceous glands and follicles are clogged with keratin, the area affected by rhinophyma is a lymphatic interfollicular inflammatory infiltrate. If the rhinophyme progresses, then granulomas are observed and often giant sebaceous glands empty into a normal sinus. With rhinophyme, it is clearly visible that most of the hypertrophied tissue consists of dilated vessels with thin walls. The skin affected by rhinophyma is more susceptible to the development of neoplasms.
Rhinophyma occurs in several varieties:
Granular forms are diagnosed more often, nasal skin growths in this case look outwardly like rough nodes. The consistency of the nodes is soft, and the surface of the area affected by rhinophyma is glossy greasy with a bluish and less often purple hue.
The fibrous form of rhinophyma is less common, with this form the skin layers are also hypertrophied, but the skin is dense, which preserves the configuration of the nose. The surface is smooth, shiny from the enlarged pores, sebum may be secreted, which, when interacting with air, acquires an unpleasant odor. On palpation, pronounced hyperplasia of the sebaceous glands of various densities is felt.
Fibroangiomatous rhinophyma is clinically similar to the fibrous form of rhinophyma, but on palpation the nodes are more elastic and soft. Due to the large number of telangiectasias, the surface of the nose has a dark red color. Rhinophymes differentiate this form from the rest by the presence of a large number of superficial and deep pustules. The contents of the pustules are bloody-purulent, which shrinks into crusts as they are evacuated. In addition to difficulty breathing, patients complain of itching, soreness and paraesthesia.
The actinic form of rhinophyma has a more benign course, the layers of the dermis thicken evenly and slightly, the nose acquires a bluish color, telangiectasia is localized mainly on the wings of the nose. In this form, rhinophyma pustules are absent, and the mouths of the sebaceous glands are slightly expanded, as a result of which sebum is separated moderately without the formation of crusts on the surface of the nose. The main pathogenetic component of actinic rhinophyma is actinic elastosis.
The course of the rhinophyme is long, with a series of stages of the process subsiding and stages of active growth. As a rule, the active growth of the rhinophyme is observed in the first years of the disease, after a few years the growth may completely stop, but the reverse development of the rhinophyme is not observed. Rhinophyme makes nasal breathing difficult, and with huge sizes and food intake, despite the fact that the pathological process does not affect the cartilage, the pressure from the overgrown rhinophyme on them is so great that the nasal cartilages are deformed or subjected to complete destruction.
Diagnostics
The dermatologist usually makes the diagnosis of “Rhinophyma” on the basis of a visual examination, the history of the disease and the patient’s life history. When pressed, a white paste-like secret is released from the deeply retracted mouths. The results of cytological examination of the discharge make it possible to accurately diagnose, microscopy reveals epithelial cells in large numbers, sebum, saprophytic microflora, pathogenic microflora may not always be present, the presence of mites of the demodex type is also not always observed.
Despite the vivid and specific clinical manifestations of rhinophyma, it needs to be differentiated from demodecosis, since rhinophyma can be complicated by demodecosis, but the latter is not the main pathogenetic mechanism; cutaneous T-cell lymphomas, sarcaidosis and lymphatic leukemia can also be manifested by growths of the skin tissue of the nose. Additional examinations, such as tissue biopsy, followed by histological analysis, help to exclude or confirm the diagnosis of “Rhinophyma”.
Treatment
Therapeutic methods of rhinophyma do not bring results, and therefore various methods of surgical treatment are used. Dermabrasion of the affected area of the skin with rhinophyma gives good results with minor tissue overgrowth and in the initial periods of the disease. Subcutaneous excision of overgrown tissues and wedge-shaped excision of areas affected by rhinophyma with intradermal sutures are indicated for deep lesions of the nasal skin and when it is impossible to use other methods of surgical treatment of rhinophyma.
Laser therapy of rhinophyma in the course of treatment allows you to simulate the disfigured shape of the nose, that is, therapeutic and aesthetic effects are achieved. If a minor area is affected by rhinophyma, then laser removal of the overgrown dermis is indicated. The process of epithelialization occurs 7-10 days after the procedure. The radio wave method in the treatment of rhinophyma allows you to quickly and effectively eliminate all clinical manifestations and restore the shape of the nose. With this treatment, there is practically no blood loss, there are no edema, the probability of postoperative complications is minimal, and the rehabilitation process is short.
Sometimes, with layered excisions of the rhinophyme, patients need nose plastic surgery to restore its shape and achieve an aesthetic appearance. But the main point in therapy is the partial removal of apparently unchanged tissues in order to reduce the likelihood of a recurrence of rhinophyma. With a properly performed operation, relapses occur only in a few percent of patients.
Prevention
There is no specific prevention of rhinophyma, but timely treatment of pink acne and rosacea reduces the risk of rhinophyma. After surgical treatment of rhinophyma, patients should avoid sudden temperature changes, review their diet and, if necessary, change their place of work.
