The unsightly redness, papules and pustules of rosacea can be controlled with medical therapy combined with lifestyle modifications. But untreated symptoms may progress to rhinophyma, a conspicuous condition that sometimes appears at the advanced stage of this common and embarrassing disorder. Most often occurring in men, rhinophyma is the red swollen nose often mistakenly attributed to heavy drinking, such as in the case of the late comedian W. C. Fields.
What causes rhinophyma? Although many factors have been suggested, the exact cause is uncertain. The swelling that often follows a flushing reaction may, over time, lead to the growth of excess tissue (fibroplasia) around the nose as plasma proteins accumulate when the damaged lymphatic system fails to clear them.1 Leakage of a substance called blood coagulation factor XIII is also believed to be a potential cause of excess tissue.
The good news is that once rhinophyma has developed, surgical therapy is now available that can return the nose to normal proportions.
Early treatment with a type of laser called the pulse dye laser can help shrink the nose to normal size. The procedure can be performed on an outpatient basis, causes no surface damage and requires no anesthetic. The same procedure also can be used to remove visible blood vessels (telangiectasia) that often develop with rosacea.
A different type of laser -- the CO2 laser, which requires a local anesthetic -- can be used as a bloodless scalpel to remove excess tissue and recontour the nose if necessary.
Wilkin JK: Rosacea: Pathophysiology and Treatment. Archives of Dermatology. 1994;130:359-362.