[Rhinophyma, management methods and oncological risk]

Rhinophyma is the most advanced stage of rosacea (stage IV). It is a benign lesion but aesthetically disabling. We present through a major case of rhinophyma and a review of the literature the diagnostic modalities, the therapeutic alternatives and the risks to be known. Particularly, we detail the risks of oncologic transformation of these poorly known lesions.The management of these rare lesions is based on a collaboration between the surgeon and the dermatologist.

Successful Treatment of Rhinophyma With Fractionated Carbon Dioxide (CO2) Laser in an African-American Man: Case Report and Review of Literature of Fractionated CO2 Laser Treatment of Rhinophyma

Rhinophyma, a late complication of rosacea (phymatous subtype), is a chronic, progressive dermatological condition. The classic pre- sentation of rhinophyma is nodular, thickened skin over the distal nose, and is often accompanied by underlying erythema secondary to in ammation. Due to the unpleasant aesthetic and dis guring appearance, rhinophyma may be associated with a signi cant nega- tive psychosocial impact, resulting in decreased patient quality-of-life. Treatment of rhinophyma is challenging as topical and systemic pharmacotherapies have shown limited ef cacy. We present a case of a 39-year-old African-American male with long-standing, mild rhinophyma who was successfully treated with two sessions of fractionated carbon dioxide (CO2) laser. We also review the medical literature on fractionated CO2 laser treatment of rhinophyma. To the best of our knowledge, this is the rst report of successful treat- ment of rhinophyma using fractionated CO2 laser in an African-American man (Fitzpatrick VI). We believe that fractionated CO2 laser may be a safe and ef cacious treatment modality for rhinophyma in skin of color patients (Fitzpatrick IV-VI) and early intervention with fractionated CO2 laser to prevent rhinophyma worsening may yield better results than late intervention. <em>J Drugs Dermatol. 2016;15(11):1465-1468.</em>.

[A giant rhinophyma]

Rhinophyma is an infiltrative-productive stage of rosacea characterized by the formation of inflammatory nodes, infiltrates, and tumour-like outgrowths due to progressive hyperplasia of the connective tissue and sebaceous glands as well as persistent vasodilatation as a result of a chronic progredient disease. The authors describe a man with the severe form of rhinophyma in whom this condition was treated by the application of a cold plasma. A good cosmetic result with minimal scarring was achieved by this method.

Rosacea

Rosacea, a common disease in adults, has an extremely variable presentation. Severity is also highly variable and, to some degree, the location of mild end of the rosacea spectrum is in the eye of the beholder. Rosacea has been noted since at least the Middle Ages. The red-faced drunk and the swollen nose of the self-indulgent are images from Shakespeare and Chaucer that have been used in modern political cartoons as well. This association with alcohol and excess is unfortunate since most patients are neither alcoholic nor dissipated.

Unusual cystic variant of rhinophyma

Rhinophyma is a slowly progressive, disfiguring disorder of the nose seen almost exclusively in men. It consists of large nodular masses of hypertrophic and hyperemic connective tissue and sebaceous glands. We present an 89-year-old white man with an unusual cystic variant of rhinophyma. While rhinophyma has 2 different presentations, our case contains not only both spectrums of histologic findings but also multiple cysts. These cysts were present on gross pathologic and microscopic examination and contained both squamous and mucinous epithelium.

[Rhinophyma--diagnosis and treatment]

The authors present four cases with rare disease--rhinophyma. These disease occurs mainly in males of middle and old age. It results from long-standing rosacea in some patients. Risk factors are blood vessels disorders, endocrinal abnormality, digestive tract disorder. In laryngological practice there are many methods of non-surgical treatment of rhinophyma. The aim of the treatment is to remove deformation and restore function of the nose and prevent the relapse of rhinophyma. Rhinophyma is removed with the epidermis and the wound is realest to self epithelisation in case of small changes, but in more severe cases of rhinophyma the wound needs to be covered by skin scalp.

[Microcystic adnexal carcinoma (malignant syringoma) of the nose: case report and review of the literature]

A case of Malignant Syringoma (syn. = Microcystic Adnexal Carcinoma, Sclerosing Swat Duct Carcinoma) of the nose in a 44 year old female patient is reported. The tumor had been misdiagnosed as a Rhinophyma some 20 years before and had thus been treated under cosmetic aspects. Besides the appearance, the patient did not suffer any complaints and was referred to the ENT-department of the Klinikum Hannover for cosmetic reasons. Histopathological examination after removal revealed a malignant syringoma, which, due to its extensive size and subepithelial growth pattern, made a complete ablation of the entire nose and the adjacent soft tissue of the face necessary. Pathohistologically cellular atypia, invasive growth pattern, perineural and perivascular infiltration was characteristic. Quantitative DNA anaylsis revealed a tumor with a diploid stem line and only few aneuploid cells. Malignant syringoma is a rare differential diagnosis of face skin tumors. The present case is discussed based on a review of the literature.

Angiosarcoma of the face resembling rhinophyma

We report the case of a 69-year-old man who had a persistent lesion develop on his nose during a 1-year period of time that was diagnosed as rhinophyma. Despite laser treatment the lesion continued to grow. Histopathology and immunohistochemical studies were consistent with cutaneous angiosarcoma. Rhinophyma-like features should be considered as an unusual clinical manifestation of cutaneous angiosarcoma.

A case of sarcoidosis mimicking rhinophyma

A 54-year-old man presented with symmetric, bulbous, nodular enlargement of his nasal tip and ala. At first inspection, the changes appeared to be consistent with rhinophyma, but biopsy revealed noncaseating granulomata consistent with sarcoidosis. His laboratory, radiographic, and functional studies were consistent with systemic involvement of his disease.

Rhinophyma: review and update

LEARNING OBJECTIVES

After studying this article, the participant should be able to discuss: 1. Clinical features and anatomy of rhinophyma. 2. The etiology and epidemiology of rhinophyma. 3. Associated diagnosis that can complicate rhinophyma. 4. Common nonsurgical and surgical therapies for rhinophyma. 5. A safe and integrated treatment plan for the patient with rhinophyma.

[Alcohol and the skin]

The cutaneous changes typical of patients, who are alcohol misusers have been reported in this study. We discuss also certain skin disorders which seem to be affected by alcohol misuse. We made an attempt to explain the ways of the influence of alcohol on mentioned skin diseases. It seems some skin disorders may be markers of alcohol misuse. Physicians who see patients with these particular diseases should be aware that there is a greater chance a patient is also an alcoholic. This additional risk factor needs to be considered when physicians design a treatment strategy.

Angiosarcoma arising on rhinophyma

We report an 82-year-old man who presented with a tumor which had developed over the previous year on the right nasal ala of a rhinophyma. Histopathological, immunohistochemical, and electron microscopic study confirmed the diagnosis of angiosarcoma on the head and neck. He was treated with radiotherapy of the tumor and cervical adenopathy, which developed later. The possible etiological and pathogenetic role of lymphedema due to inflammatory flares of rosacea on the nose is discussed, together with the histological and immunohistochemical data leading to the diagnosis of this tumor.

Giant rhinophyma--a case report

Rhinophyma is an uncommon condition that often results in both functional and cosmetic impairment. A 65-year old male with a huge rhinophyma, that had extremely grown in the last three years, is presented. The huge tumor was removed under local anaesthesia with electrosurgical knife preserving the alar cartilage. Both, the immediate and late result were satisfactory. The relevant literature is discussed.

Sarcoidosis of the external nose mimicking rhinophyma. Case report and review of the literature

A 52-year-old man with a large external nasal mass is presented. Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections. The case is discussed in detail, along with a review of the literature pertaining to sarcoidosis of the nose and nasal cavity.

[Granuloma eosinophilicum faciei simulating rhinophyma. Therapeutic long-term outcome after surgical intervention]

A 53 year old man presented with a giant variant of granuloma faciale, closely resembling rhinophyma. Therapeutic approaches with cryosurgery and dapsone were unsuccessful. Surgical reconstruction of the nasal skin resulted in an excellent and long lasting effect. We give a short overview of this relatively rare disease, describe an unusual manifestation and discuss the therapeutic possibilities. Surgical procedures seem to offer the best results, despite the inflammatory pathogenesis of the disease.

Rhinophymalike metastatic carcinoma

Cutaneous metastases from internal carcinoma vary in their clinical appearance. An unusual presentation, initially resembling rhinophyma, is described in a 71-year-old man with lung cancer. The clinical variations of metastases to skin are reviewed.

Rhinophyma-like cryptococcal infection as an early manifestation of AIDS in a hemophilia B patient

A hemophilia B patient, seropositive for HIV antibodies since 1984, came to us in March 1989 with a severe necrotizing lesion of the nose. It was an erythematous lesion and looked like rhinophyma. Microbiological examination of the skin biopsy showed the presence of Cryptococcus neoformans. At the time of the study, the patient was in partial remission after 2 weeks of therapy with fluconazole per os 400 mg/day. He will be treated with the same therapy at maintenance dose (200 mg/day) for a long period.

[Unusual aspects of a case of rhinophyma]

The present paper reports on a case of rhinophyma associated with pendulous fibroma, operated in the same surgical sequence, with grafting the decortication surface of the pyramid with graft of free skin taken from the arm. The clinical and histological characteristics of the case presented and the conclusions to be drawn from it are outlined, as the disease is a nosologic entity rarely met.

[Rhinophyma]

The authors review the etiology, diagnosis, and treatment of rhinophyma. A surgical technique, combined with other techniques is described including the use of steell bistoury, electric bistoury, dermoabrassor, fibrin glue.