Successful skin healing without any graft reconstruction after scalpel blade paring of huge rhinophyma: a case report and review of literature

Rhinophyma is considered as a benign tumor of the exterior of the nose. It is a disfiguring soft tissue hypertrophy of the nasal skin, predominantly seen in older, white men. It is believed to be the final stage of acne rosacea. The main presentation of the patients with rhinophyma is the cosmetic disfigurement, although it may also cause nasal obstruction and visual disturbance. The rhinophyma is mainly treated by surgical intervention, which exists in different forms, but all will provide almost similar cosmetic results. Our presentation constitutes one case of rhinophyma treated by paring with a sharp scalpel. The case showed satisfied cosmetic results with a complete healing of the raw area without any skin graft reconstruction.

Surgical treatment of rhinophyma: Retrospective monocentric study and literature review

BACKGROUND

Treatment of rhinophyma consists primarily of destructive procedures. There is currently no consensus regarding treatment. In this study, we propose an algorithm based on a cohort of 25 patients and a literature review.

PATIENTS AND METHODS

This was a retrospective study conducted between January 2016 and December 2018. The cosmetic outcome was evaluated by 2 independent assessors based on pre- and postoperative photographs. Patients were ranked according to the severity (mild, moderate, severe) of their rhinophyma. The different surgical methods used were cold blade excision or rhinoshave, electrosurgery or monopolar diathermy knife (MDK), and carbon dioxide laser (CO₂ laser), either alone or in combination with another technique. All patients were contacted after the procedure to evaluate their satisfaction and to investigate for adverse effects.

RESULTS

Twenty-five patients were included retrospectively: 7 with mild rhinophyma (5 were treated by MDK, 1 by fractional CO₂ laser, and 1 by cold-blade excision and TCA solution), 11 with moderate rhinophyma (2 were treated by MDK, 9 by continuous CO₂ laser), and 7 with severe rhinophyma (2 were treated by MDK, 5 by MDK plus CO₂ laser). Cosmetic outcomes were deemed good or excellent in 80% of cases, and 84% of patients were fully satisfied with the result. We observed 5 cases of hypertrophic scarring, 2 cases of hypopigmentation, 3 cases of notching of the nasal ala, and 7 cases of prolonged erythema, most of which were caused by the MDK technique.

CONCLUSION

A wide range of treatment options are available for rhinophyma. We suggest the use of cold-blade excision and trichloroacetic acid or fractional carbon dioxide laser for mild rhinophyma, continuous and pulsed CO₂ laser for moderate rhinophyma, and MDK for severe rhinophyma.