This swollen skin on the nose is called “rhinophyma.”
When most people think of rosacea, they likely think of reddened skin and visible blood vessels. However, other types of rosacea may cause different symptoms, such as thickening skin, or phyma. This thickened, swollen skin is caused by a type of rosacea known as phymatous rosacea.
“Phymatous rosacea is really the enlargement of the sebaceous glands,” says Michelle Henry, MD, dermatologist in New York City and clinical instructor at Weill Cornell Medical College. These are the glands that secrete sebum oil to hydrate your skin and hair.
Like many symptoms of rosacea, this enlargement of the sebaceous glands is linked to inflammation. After years of chronic inflammation in the skin, the sebaceous glands swell, causing the skin to have a thickened appearance. Most commonly, phyma occurs on the nose, which is called rhinophyma.
“Initially, patients will start to see little lumps and bumps, smaller areas of thickening,” says Dr. Henry. “With time, it will become larger and larger, and then ultimately, you’ll have that kind of classic bulbous nose … so it is a gradual process.” In severe cases, the nose may become so swollen that it obstructs breathing through the nose.
The best way to treat phyma (which comes from the Latin word for “swelling”) is to prevent it altogether. By treating rosacea symptoms and making lifestyle changes to reduce rosacea flares, you can minimize inflammation and reduce the risk of developing phyma. Treatment may also include oral and topical medications.
Treating already thickened skin is a bit more difficult. “Once you have that thick phymatous tissue, you really have to get rid of it surgically,” says Dr. Henry.
There are a few different approaches to surgically remove phyma. Traditionally, a surgeon would just reshape the nose with a standard scalpal. However, newer options aim to reshape the nose with less pain and bleeding, using techniques like high-frequency electric currents, loop cautery (a loop-shaped wire), dermabrasion, and laser therapy. These various methods help break down or shave down the thickened skin and reshape the nose to its previous appearance.
Again, treating your rosacea early can help prevent phyma—and the need for surgery. “Make sure that you see a professional, to make sure that you’re having the appropriate treatments for your level of severity.”
Dr. Henry is a board-certified dermatologist and dermatologic surgeon in New York City, and a clinical instructor at Weill Cornell Medical College.
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Phymatous rosacea is really the enlargement
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of the sebaceous glands.
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This chronic inflammation after years and years and years,
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you start to get this reactive response of the sebaceous glands
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and then those areas become really thick,
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they can become protuberant,
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and they can be really disturbing for patients.
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If you biopsy an area of phymatous skin,
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you're gonna see really enlarged oil glands,
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and that's what happens with the time.
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It is a gradual progression.
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Initially, patients will start to see little lumps and bumps,
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smaller areas of thickening.
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Then ultimately, you'll have that kind of classic bulbous nose
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that you see with rosacea.
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Picking up on those early signs and trying to treat it aggressively
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may help to slow the progression.
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We're treating it with either oral or topical medications.
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But once you have that thick, phymatous tissue,
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you really have to get rid of it surgically.
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So we're either using loop cautery,
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which is essentially taking kind of a hot needle
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to break down that tissue,
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or we're using a blade of laser treatments
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to really carve out the nose and restore it to its original aesthetic.
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And make sure that you see a professional,
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so that you're having the appropriate treatment
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for your level of severity.
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Aferzon M, Millman B. Excision of rhinophyma with high-frequency electrosurgery. Dermatol Surg. 2002 Aug;28(8):735-8.
Rhinophyma. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on February 24, 2020 at https://medlineplus.gov/ency/article/001037.htm.)
Rosacea: pathogenesis, clinical features, and diagnosis. Waltham, MA: UpToDate, 2020. (Accessed on February 24, 2020 at https://www.uptodate.com/contents/rosacea-pathogenesis-clinical-features-and-diagnosis.)