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

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.  

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.