Rhinophyma is a benign proliferative disorder of the nose that represents a severe complication of rosacea.1,2 Clinically, the condition exists on a spectrum but involves thickening of nasal skin and irregular surface nodularities. In mild and moderate rhinophyma, there is hypertrophy of soft tissue, dilated and enlarged pilosebaceous units but preservation of the nasal shape. In severe forms of rhinophyma, smooth hypertrophic nodules are observed and the nasal shape is distorted. Rhinophyma varies histologically according to its clinical presentation. Early forms of the condition demonstrate the typical findings of rosacea including sebaceous hyperplasia, prominent vascularity, and perifollicular inflammation. More severe forms, however, demonstrate marked fibrosis and absence of pilosebaceous units with prominent mucin deposition and lymphedema. The presence of rhinophyma in any form can be greatly distressing to patients. Historically, rhinophyma has been associated with the overuse of alcohol although that association has been largely dispelled. The disfigurement can also cause functional impairment with breathing due to nasal obstruction. For these reasons, patients often seek care to correct the deformities caused by this condition. Medical treatment modalities have been described including tetracycline class of antibiotics and isotretinoin. Unfortunately, these medications do little to reverse the phymatous changes once fibrosis is present although isotretinoin has been shown to reduce nasal volume in the prefibrotic stage. Once fibrosis and significant nodularity have developed, physical treatment modalities are the preferred technique. Physical treatment options have varied significantly
through time and have included decortication, cryosurgery, total excision and grafting, loop electrocautery, and laser therapy.4-6 A variety of different laser devices have been utilized with positive
results reported, including erbium:YAG, continuous wave carbon dioxide (CO2), pulsed CO2, diode, and fractional CO2. The following two cases describe the treatment of rhinophyma, using the Syneron CO2RE CO2 platform, which offers a combination of surgical, classic, and fractional CO2 treatment options.
Matthew J. Mahlberg, MD, Lake Loveland Dermatology, Loveland, CO, USA
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