Rhinophyma

What It Is, Causes, Diagnosis, Treatment, and More

Author: Maria Giulia Boemi

Editor: Alyssa Haag

Editor: Lily Guo

Editor: Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Modified: Jan 06, 2025

What is rhinophyma?

Rhinophyma refers to a nasal deformity caused by hyperplasia, or proliferation, of the sebaceous glands (i.e., oil glands) and connective tissue of the nose. The term rhinophyma derives from the Greek words “rhis,” meaning nose, and “phyma,” meaning skin tumor to describe its appearance. Rhinophyma can occur as a manifestation of rosacea, an inflammatory skin condition that typically affects the central face. It specifically represents the most common symptom of phymatous rosacea, a type of rosacea in which glandular hyperplasia, skin thickening, and fibrosis are present. Significant functional and cosmetic impairments may occur as a result of rhinophyma and could therefore require treatment.

An infographic detailing the background, causes, symptoms, diagnosis, and treatment of rhinophyma; including lateral view of nose.

What causes rhinophyma?

Rosacea, and in turn rhinophyma, are caused by a dysregulation in the innate immune system in which overexpression of toll-like receptors and increased activation of nuclear factor kappa B (NK-κB) lead to excessive release of proinflammatory cytokines, macrophages, and mast cells. Mast cells promote dilation of blood vessels and angiogenesis, or the development of new blood vessels, which lead to increased vascular permeability, erythema, and edema. Extreme weather, caffeine, alcohol, exercise, and emotional stress have been identified as potential triggers for this dysregulated immune response and may lead to rosacea flares. The ultimate underlying cause of the immune dysregulation found in rosacea and rhinophyma is thought to be multifactorial and is not completely understood.

Rosacea and rhinophyma are most commonly seen in individuals of Northern European descent. Rosacea more commonly affects genetic females and typically presents in the fourth to fifth decade of life. On the other hand, rhinophyma more commonly affects genetic males aged 50 years or older. Despite historical misconceptions, there is no known direct causal association between the development of rhinophyma and alcohol use.

What are the signs and symptoms of rhinophyma?

Findings of rhinophyma may include nasal skin thickening, a bulbous shape of the nose, or irregular nodules of the nose that may interfere with nasal structure or appearance. If severe, nasal skin thickening may cause nasal obstruction and lead to difficulty breathing. Other symptoms may include those associated with rosacea such as intermittent facial flushing, erythema, sensitivity of the facial skin or eyes, burning of the eyes, and pustules, usually of the central face that may occur in cycles. Signs of rosacea may also be present with rhinophyma such as transient or persistent facial erythema, papules, pustules, small dilated blood vessels (i.e., telangiectasias), ocular infiltrates and discharge, or redness of the eyes (i.e., conjunctival injection).

How is rhinophyma diagnosed?

Clinical evaluation is used to diagnose and subtype both rosacea and rhinophyma. The National Rosacea Society developed diagnostic criteria for rosacea based on clinical signs that are divided into primary (e.g., erythema, telangiectasias) and secondary features (e.g., facial hypersensitivity, phymatous changes). One primary criterion and one secondary criterion are required for diagnosis. Rhinophyma is also a clinical diagnosis that may be further classified by severity or graded based on the parts of the nose affected, the degree of nasal skin thickening, and whether nodules are present. Laboratory tests or imaging studies are not required for diagnosis. A skin biopsy may occasionally be used to confirm the diagnosis if clinical evaluation yields uncertainty.

How is rhinophyma treated?

In the early stages of rhinophyma, treatment may include topical or oral metronidazole, oral isotretinoin, and oral tetracyclines. Later stages of rhinophyma may be managed with surgery and laser treatments. Various surgical techniques and types of laser treatment may be used separately or in combination to remove affected tissue, promote new skin growth, and preserve cosmetic appearance. Treatment also focuses on addressing the potential psychological impact that may result from a change of appearance secondary to rhinophyma. Multidisciplinary care from dermatology, otolaryngology, plastic surgery, psychiatry, and others is imperative to provide appropriate treatment.

The treatment of underlying rosacea may consist of topical antibiotics (e.g., metronidazole), oral antibiotics (e.g., tetracyclines), and oral isotretinoin depending on the symptoms present. Topical alpha-adrenergic agonists, like brimonidine, may also be used to treat the erythema through the constriction of blood vessels. Laser treatment may also be used to reduce the appearance of telangiectasias. Though rosacea typically responds well to treatment, treatment may not prevent the development of rhinophyma.

What are the most important facts to know about rhinophyma?

Rhinophyma is a nasal deformity that occurs as a symptom of rosacea. While the underlying cause of rhinophyma is unknown, it is known that immune system dysregulation leads to the inappropriate proliferation of sebaceous glands and connective tissue of the nose. Signs and symptoms of rhinophyma may include those of rosacea (e.g., facial erythema, pustule formation, facial sensitivity, telangiectasias) in addition to thickening and fibrosis of nasal skin, nodule formation, and potentially nasal obstruction. Rhinophyma is typically diagnosed by clinical evaluation, however, in atypical cases a skin biopsy may be necessary to confirm diagnosis. Common treatment options may consist of topical or oral antibiotics and oral isotretinoin in early stages but most often can require surgical and laser management.

References

Dick MK, Patel BC. Rhinophyma [Updated 2023 Aug 8]. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK544373/

Gao Y, Farah R. Acne, Rosacea, and Related Disorders. In: Soutor C, Hordinsky MK. eds. Clinical Dermatology: Diagnosis and Management of Common Disorders, 2e. McGraw-Hill Education; 2022. Accessed March 19, 2024

Liu A, Al-Lami A, Kapoor K. Rhinophyma: When Red Nose Day is no laughing matter. British Journal of General Practice. 2019;69(680):137-137. doi:https://doi.org/10.3399/bjgp19x701585