Although subtype 3 (phymatous) rosacea often involves excess tissue, it can be effectively treated with a range of options appropriate for the severity of the case, according to the standard management options for rosacea recently published by the National Rosacea Society.1
"Enlargement of the nose, known as rhinophyma, is the most common form of phymatous rosacea, and tends to develop along a spectrum from facial swelling and enlarged pores to the development of excess tissue," said Dr. Mark Dahl, professor of dermatology at the Mayo Clinic-Arizona and a member of the consensus committee that developed the new standard options. "Although relatively rare, rhinophyma occurs primarily in men. Ideally, it will be identified and treated early, but there are options that can restore even an advanced case to a normal appearance."
During its early stage, where there may be dilated pores but not changes in contours, topical therapy and oral antibiotics may be appropriate. Oral isotretinoin, used to treat severe acne, has been demonstrated to decrease nasal volume, especially in patients with less advanced disease, though the size may increase again after therapy is stopped, the committee noted.
More severe rhinophyma -- where there is growth of excess tissue as well as possible bumps and pimples -- may require surgical therapy, Dr. Dahl noted. Surgical options may include lasers, cryosurgery, radiofrequency ablation, electrosurgery, a heated scalpel, electrocautery and tangential excision, combined with scissor sculpturing, skin grafting or dermabrasion.
A CO2 or erbium:YAG laser may be used as a bloodless scalpel to remove excess tissue and recontour the nose, and fractional resurfacing may be of value in mild cases.
"Fortunately today, appropriate treatment options are available that can remove the effects of rhinophyma with minimal discomfort," Dr. Dahl said.
- Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis. 2009;84:97-104.