Wound excision and closure by secondary intention and growth factor application in the management of rosacea complicated by giant rhinophyma.

BACKGROUND: Rosacea is a significant problem, affecting 5.5% of the world population. Currently used treatment techniques such as transfer flaps and implants are insufficient to meet the needs of many patients, which suggests that alternative approaches are needed. CASE REPORT: This report describes a case of rosacea complicated by giant rhinophyma treated with excision and closure by secondary intention and growth factor application. The patient was admitted to the Department of Dermatology at The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, in July 2021, and underwent excision of the external nasal redundancy under general anesthesia. The postoperative wound was left open. The patient's wounds healed completely 2 months after surgery, and there was no recurrence at 6-month follow-up. The wounds recovered well, with only slight scarring. CONCLUSION: The positive outcomes for this patient suggest that wound excision and closure by secondary intention and growth factor application may be beneficial for patients with rosacea complicated by giant rhinophyma.

[Rosacea-the updated S2k guideline]. / Rosazea ­ die neue S2k-Leitlinie.

Rosacea is a common chronic inflammatory dermatosis of the face, clinically characterized by erythema, telangiectasia, papules, pustules, and rhinophyma. In January 2022, the updated guideline on rosacea was published. Groundbreaking innovations include the new clinical classification according to phenotypes, extended diagnostic and therapeutic recommendations for ocular rosacea and implications of the gut microbiome on rosacea. Furthermore, the guideline encompasses a new chapter on the psychosocial aspects of rosacea and detailed recommendations for approved and off-label therapies.

A retrospective 10 years- experience overview of dye laser treatments for vascular pathologies.

INTRODUCTION: The Flash-lamp pulsed dye laser (FPDL) is nowadays considered the most precise laser currently on the market for treating superficial vascular lesions. In this study, we gathered data from 10 years of experience regarding dye laser treatment of patients presenting vascular malformations such as telangiectasia, rhinophyma, port-wine stain, cherry and spider angioma and vascular tumours. METHODS: Subjects were enrolled from 2013 to 2023 based on the vascular anomalies they presented. They underwent different treatment sessions with the FPDL device. RESULTS: The age-range distribution by vascular anomaly confirmed that haemangiomas are typical in children while rhinophyma is a condition very common in older adults. A difference in sex distribution showed that pathologies such as telangiectasias typically affect women whereas rhinophyma is more frequent in men. Most of the treatments interested the face area but no permanent side effects were registered. CONCLUSIONS: Our 10 years of experience with FPDL demonstrated good results in a wide range of applications for the treatment of different vascular anomalies. The absence of long-term side effects and bearable pain during the treatment makes it a valuable solution for the resolution of benign tumours also in very young patients.

Rinofima: reporte de un caso de Clínica Estrella / Rhinophyma: a case report of Clínica Estrella

La rinofima es una patología que se caracteriza por presentar hipertrofia de las glándulas sebáceas con proliferación de tejido fibroso, donde la nariz toma un aspecto lobulado dando como resultado la deformidad de la punta nasal; es una forma de rosácea. La prevalencia de esta variedad de rosácea es de aproximadamente un 5-7% en la población y con predominio en el sexo masculino de la quinta a séptima década de vida. Su etiología no se conoce con exactitud. Se presenta el caso de un paciente masculino de 84 años, con antecedentes patológicos de hipertensión arterial e hipotiroidismo; su lesión inició hace 10 años, como una lesión eritematosa con presencia de telangiectasia a nivel de alas y punta nasal, no dolorosa. Se realizó tratamiento con bisturí frío y radiofrecuencia, se realizaron cortes transversales hasta dejar el lecho desprovisto del tumor y finalmente se usó radiofrecuencia en toda la superficie de la lesión restante. Se realizó el procedimiento ambulatorio sin complicaciones inmediatas o tardías

Rhinophyma is a pathology characterized by hypertrophy of the sebaceous glands with proliferation of fibrous tissue, the nose has a lobed appearance, as a result there is a deformity of the nasal tip; rhinophyma is a form of rosacea. The prevalence of this variety of rosacea is approximately 5-7% in the population and predominantly in males from the fifth to seventh decade of life, the etiology is not well known, however there are several predisposing genetic and environmental factors. We present the case of an 84-year-old male patient with a pathological history of arterial hypertension and hypothyroidism; his lesion began 10 years ago, as an erythematous lesion with presence of telangiectasia in the wings and nasal tip, not painful. Treatment was performed with a cold scalpel and radiofrequency, transverse cuts were made until the tumor was gone, and finally radiofrequency was used on the entire surface of the remaining lesion. The outpatient procedure was performed without immediate or late complications.

Angiosarcoma Mimicking Rhinophyma.

This case report describes a man in his 60s who was referred to the department of dermatology for further evaluation of a lesion on the nose.

Rinofima. Desfiguración estética de la anatomía nasal / RHINOPHYMA. AESTHETIC DISFIGURATION OF THE NASAL ANATOMY

Se describen distintos aspectos del rinofima: historia, etiopatogenia, histopatología, epidemiologia, clínica, diagnósticos diferenciales, tratamientos y pronóstico. Se hace hincapié en que es una enfermedad localizada en la nariz asociada a desórdenes generales, y que repercute en las áreas psicológica y social. Se presenta un caso clínico operado con cirugía plástica. Los autores plantean una hipótesis sobre la etiopatogenia y la fisiopatología de la enfermedad; y consideran a los tratamientos de rinofima como paliativos y no curativos

Different aspects of rhinophyma were described: history, etiopathogeny, histopathology, epidemiology, clinical, differential diagnoses, treatments and prognosis. It is emphasized that it is a localized disease in the nose associated to general disorders, and that it brings psychological and social problems. We present a case operated with plastic surgery. The authors present a hypothesis about the etiopathogeny and pathophysiology of the disease and consider rhinophyma treatments as palliative and non-curative.

A Novel Surgical Approach for Rhinophyma: Experience From a Cohort of Thirty Patients.

BACKGROUND: Rhinophyma is the severe rosacea whit hypertrophy of sebaceous glands in nasal tissue, which severely influences the patient's appearance. Surgical therapy is the best method for treating moderate-to-severe rhinophyma. In this study, we used a new ameliorated scarification for 30 patients with moderate-to-severe rhinophyma. OBJECTIVE: To observe the effect of five-blades scratcher surgery on moderate-to severe rhinophyma between 2016 and 2019 in our center. MATERIALS AND METHODS: A total of 30 patients were treated with five-blades scratcher under tumescent anesthesia. Outcomes were determined by a patient questionnaire. RESULTS: Of 30 patients, all of them answered the questionnaire and were included in this study with a follow-up time of 12 months. Cosmetic results were evaluated as very good or good in 90% of patients. The majority of patients (87%) were very satisfied or satisfied with the postoperative result. Surgical treatment of rhinophyma improved patients' quality of life in 67% of patients. Recurrence of rhinophyma was detected in 7% of patients. In all, 100% of the patients stated that they would recommend this treatment to others. CONCLUSIONS: Five-blades scratcher is an effective therapy for rhinophyma with excellent outcome.

A Surgical Management for Severe Rhinophyma With Five-Blade Scratcher.

ABSTRACT: Rhinophyma, the final stage of acne rosacea, severely influences the patient's appearance and can only be treated by surgical methods. This case reports a simple, safe, effective, and economical surgical method-five-blade scratcher. After the surgical treatment, the overall nasal contour of the patient, a male with severe rosacea, was restored without scar formation. Thus, this surgical method reported in this case is feasible and easy to operate, and worthy of clinical promotion.

Tratamiento Quirúrgico del rinofima / Surgical treatment of rynophyma

Introducción: El rinofima representa una deformidad progresiva de la nariz, que conduce a una alteración estética importante, sus características clínicas pueden variar, desde un enrojecimiento y ligero engrosamiento de la punta nasal, hasta un tumor deformante, diversos métodos quirúrgicos se describen para tratarlo. Objetivo: Actualizar el conocimiento de los diversos métodos quirúrgicos, en el tratamiento del rinofima. Método: Se realizó una revisión integradora, en cuatro bases de datos: ¨Medline¨, ¨Ebsco¨, ¨PubMed¨, ¨Scielo¨, se evaluaron 130 revistas de impacto y se trabajó con 40 artículos, de enero a marzo del 2020. Se utilizó el tesauro en español como ¨Rinofima¨, ¨Electrocirugía¨, ¨Electrocoagulación¨, ¨Dermabrasión¨, ¨Rinoplastia¨ y su contraparte en inglés. Conclusiones: El diagnóstico del tipo, grado de afectación de la enfermedad, recursos disponibles, así como la preparación del profesional, orienta la selección del procedimiento ideal para el paciente(AU)

Introduction: Rynophyma represents a progressive deformity of the nose, which conducts to the esthetics and important disorder, its clinical characteristics may vary, from a reddening and mild enlargement of the tip of the nose, to a deforming tumor, diverse surgical methods are described to treat it. Objective: To update knowledge of diverse surgical methods, in the treatment of Rynophyma. Method: An integrated revision was carried out, in four data bases: ¨Medline¨, ¨Ebsco¨, ¨PubMed¨, ¨Scielo¨, 130 impact magazines were evaluated and 40 articles were considered, from January to March, 2020. The thesaurus in Spanish was used for the terms ¨ Rynophyma ¨, ¨Electro surgery¨, ¨Electrocoagulation¨, ¨Dermabrasion¨, ¨Rynoplasty¨ and its counterpart in English. Conclusions: The diagnosis of the type and level of affectation of the disease, available resources, as well as the preparation of the professional, guides the selection of the ideal procedure for the patient (AU)

[The rhinophyma through the prism of time]. / Rinofima cherez prizmu vremeni.

One of the frequent causes of a significant increase in the external nose, forming a persistent deformity of the face, as well as leading to a non-standard clinical picture is rhinophyma disease. The article considers some historical data, epidemiology, peculiarities of pathogenesis, as well as the basics of surgical treatment tactics along with possible preventive measures against rhinophyma. At present, the treatment of this pathology presents great difficulties. Despite the many surgical methods, rhinophyma is poorly treatable, often relapses and leaves no less noticeable disfigurement of the face in the postoperative period. In this regard, there is a constant search for new surgical methods, which has not only medical but also important social significance.

Treatment of Rhinophyma With Fractional CO2 Laser Resurfacing in a Woman of Color: Case Report and Review of the Literature.

Rhinophyma is a disfiguring disorder that is characterized by an erythematous, hypertrophied, and inflamed lower two-thirds of the nose. Widely accepted as the severe form of acne rosacea, rhinophyma can result in functional, aesthetic, and psychosocial concerns that require treatment in a cosmetic fashion. Rosacea should be treated in its earliest manifestations to mitigate the progression towards rhinophyma; therefore, early detection and intervention is a crucial part of treatment. Little has been written on this subject in people of color. We present the first reported case of rhinophyma in a 62-year-old Fitzpatrick V female patient who was successfully treated with one session of fractional CO2 laser resurfacing. This case highlights the successful use of the fractional CO2 laser to treat rhinophyma in darker skin types (Fitzpatrick IV–VI) and underscores the potential for future use among patients of color. J Drugs Dermatol. 2021;20(7):772-775. doi:10.36849/JDD.C702.

Rinofima. Informe de tres casos / Rhinophyma. Report of three cases

El rinofima es una enfermedad notable, crea trastornos estéticos, funcionales y psicológicos,es un tumor benigno progresivo que provoca alteraciones en la morfología nasal, ocurre unahipertrofia de la epidermis y la dermis, alteración del tejido conectivo, epitelial y glandular,aparato pilosebáceo, se observa un crecimiento de la nariz que daña la estética facial. El objetivo de este informe es demostrar mediante el tratamiento quirúrgico, escisión conescarpelo (decorticación nasal) y dermoabrasión los resultados obtenidos en la función facialy la recuperación de la autoestima. Se presentan tres pacientes con diagnóstico de rinofimaque acuden a la consulta externa, con pérdida de la autoestima que repercute en lasociedad y en el entorno familiar. El tratamiento de elección es la técnica de decorticaciónnasal y dermoabrasión, sin otras alternativas quirúrgicas. Se logran efectos funcionales,estéticos y psicológicos. No se producen recidivas.(AU)

Rhinophyma is a notable disease, which creates, estheics functional and psychological disorders, it is a benign progressive tumor that causes changes in the nasal morphology, a hypertrophy of the epidermis and dermis, changes in the connective, epithelial and glandular tissues, and in the pilosebaceous system , an increasing of the nose is observed which hurts facial esthetics. The objective of this report is to show the obtained results in the facial function and the recovering of the self-esteem by the surgical treatment, excise with scalpel (nasal decortication) and dermoabrasion. Three patients are presented with diagnosis of rhinophyma who went to the out-patient consultation, complaining of loss of self-esteem with repercussion in the society and family environment. The election treatment is the technic of nasal decortication and dermoabrasion, without other surgical alternatives. Functional, esthetic and psychological effects are obtained. Residivations are not produced.(AU)

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.

Dilemmas in the management of rhinophyma in pigmented individuals.

Rhinophyma affects predominantly the Caucasian population and is rare in those with Fitzpatrick skin type IV-VI. Diagnosis is based on clinical evaluation. Prominent features include abnormal coloration and texture of skin, impaired vascularity, irregular nodular exophytic growth and telangiectasia. Management can be surgical or dermatological. Surgery remains the mainstay of treatment but achieving an acceptable aesthetic result can be challenging, particularly in those with pigmented skin. Postsurgical hyper- and hypopigmentation make for unpredictable outcomes requiring appropriate preoperative counselling. We present a case that exemplifies this issue and discuss our recommended approach to counselling, consenting and managing such dilemmas in these patients, and a proposal for further investigation into the role of autologous melanocyte transplantation in reducing the effect particularly of hypopigmentation on aesthetic outcomes in this group.