What To Know about Rhinophyma

Rhinophyma is a rare, non-cancerous skin condition. It’s a Greek term for skin thickening or growth (phyma) on the nose (rhis, or rhino). Symptoms include a large, red, bumpy, or swollen nose, thick skin, visible blood vessels, and difficulty breathing (in severe cases). 

The causes of rhinophyma aren't fully understood, but it typically develops in people with rosacea, a chronic (long-term) skin condition that affects about 5% of the population. Rosacea causes facial redness, swelling, burning, and visible blood vessels or acne-like bumps. Phymatous rosacea, a common subtype for those who develop rhinophyma, also causes skin thickening.

Contrary to popular belief, research studies verify that alcohol is not the cause of rhinophyma. However, people with rhinophyma may isolate themselves because of this belief, which leads to social stigma. While there is no cure, treatment can lessen symptoms and improve quality of life.

Types of Rhinophyma 

Fibrous tissue underneath the skin of your nose is made of strong collagen fibers that provide structure. There are also long sebaceous (oil) glands that produce sebum to protect and moisturize the skin. The following types of rhinophyma affect these tissues differently. 

• Fibrous: Involves an overgrowth of fibrous tissue
• Glandular: Causes large sebaceous glands that produce excess oil
• Fibroangiomatous: Involves fluid retention, large blood vessels, and pustules (pimples)
• Actinic: Causes lumps of elastic tissue under the skin, increases the size and number of oil glands, and widens the ducts that carry oil

Symptoms 

Rhinophyma mainly affects the lower portion of the nose, causing symptoms that develop and worsen gradually. Symptoms include:

• Bumpy skin texture
  
• Oily skin 
• Progressive enlargement
• Redness 
• Round, swollen shape
• Thick skin
• Visible blood vessels
• Difficulty breathing (rare)

What Causes Rhinophyma? 

Depending on the subtype, rhinophyma occurs due to an overgrowth of oil glands or fibrous tissue in the nose, causing it to become enlarged, red, and bumpy.

The exact reason some people develop rosacea or rhinophyma is not fully understood, but factors such as hormone imbalances or Demodex mite overgrowth may contribute. Demodex mites live on everyone's skin and are typically harmless. However, an overgrowth is seen with some types of rosacea and rhinophyma.

Actinic rhinophyma is also linked to specific bacteria called Propionibacterium acnes, yeast, sun exposure, and aging.

Risk Factors

Rosacea is more common in people assigned female at birth, but rhinophyma more commonly affects people assigned male at birth. This is likely due to how androgen hormones like testosterone affect the skin and oil glands.

Other risk factors for rhinophyma include: 

• Fair skin 
• A family history of rhinophyma 
• Age (begins around age 50 and worsens over time)
• Untreated rosacea

Diagnosis

Healthcare providers usually diagnose rhinophyma by reviewing your medical history, discussing symptoms, and conducting a physical examination. They will ask about any past diagnosis of rosacea and may use a dermoscopy or magnifying glass to examine your skin closely.

Your provider may suggest a skin biopsy, which involves examining a small skin tissue sample from the nose under a microscope. A biopsy helps confirm the diagnosis of rhinophyma by revealing specific changes in sebaceous glands and fibrous tissue. It also helps rule out other conditions, such as skin cancer.

Rhinophyma Treatment  

There is no cure for rhinophyma, but treatments aim to prevent worsening symptoms and improve the nose's appearance. You will typically also receive treatment for underlying rosacea.

Medications

Medications like oral Accutane (isotretinoin), a vitamin A derivative, can shrink oil glands and reduce skin thickening. However, it can cause side effects, so providers reserve them for severe cases.

Depending on the underlying type of rosacea and rhinophyma, your provider may also suggest antibiotics. Promising studies show that Nolvadex (tamoxifen), an anti-estrogen medication, may also slow skin thickening.

Surgery

Surgical solutions involve removing extra tissue and oil glands and reshaping the remaining tissue to make the nose look more natural. Surgical techniques may include:

• Electrosurgery: Electric currents remove extra tissue and stop bleeding.
• Excision: Surgical tools cut away excess tissue.
• Laser: A beam of light precisely removes thick skin layers.
• Plasma and radiofrequency laser: This unique type of energy rapidly heats and cools tissues, removing bumps with minimal bleeding. 
• Dermabrasion: A rotating abrasive tool smooths the skin after surgery.

How To Prevent Rhinophyma 

There's no way to stop rhinophyma completely. Surgery can help, but rhinophyma might return. Because there is a link to rosacea, early treatment and ongoing care for rosacea can help slow down rhinophyma. Here are some tips:

• Avoid rosacea triggers that cause skin flushing 
• Moisturize frequently to reduce water loss in the skin 
• Shield your skin from sun damage using sunscreen and hats
• Talk to your provider about rosacea treatment options 
• Use gentle, fragrance-free cleansers made for sensitive skin

Triggers

While this is not an exhaustive list, rosacea triggers may include:

• Extreme hot or cold temperatures
• Sun or wind exposure
• Stress
• Caffeine, alcohol, spicy foods, hot drinks
• Intense exercise
• Chemical peels, harsh skin products 
• Medications that widen blood vessels
• Niacin (vitamin B3) 
• Nicotine

Related Conditions

Rhinophyma is a phymatous (skin-thickening) rosacea that primarily affects the nose. However, those with phymatous rosacea may also develop symptoms on other parts of the face, including: 

• Gnathophyma (chin)
• Metophyma (forehead)
• Otophyma (ears)
• Blepharophyma (eyelids)

Persons with rhinophyma may also have the following subtypes of rosacea:

• Erythematotelangiectatic: Facial redness and visible blood vessels.\
• Papulopustular: Involves acne-like bumps
• Ocular: Causes eye redness, irritation, and dryness

In addition, the following health conditions may occur along with rosacea or rhinophyma:

• Acne
• Diabetes
• Heart or blood pressure conditions
• Hormone imbalance
• Mental health disorders
• Sinus congestion or infection
• Skin cancer
• Stomach conditions

Living With Rhinophyma 

Rhinophyma is a long-term, non-cancerous skin condition that doesn't directly affect overall health or life span. However, its physical changes can affect self-confidence. Some people use makeup or special skincare products to conceal redness or uneven skin texture.

Medical treatments may also help. Around 90% of people who receive treatment for rhinophyma recommend it, regardless of the type of treatment they undergo. One older study found that all 52 patients who had surgery for rhinophyma in the past five years were happy with the results.

Surgery isn't always a permanent fix. Another study shows that almost half (47%) of those who had surgery saw the rhinophyma slowly return.

Researchers are studying new treatments, including better lasers, oral medications, and creams. This could lead to even better results in the future.