Medical Negligence in Otorhinolaryngology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Rhinophyma is a bulbous enlargement of the nose and is caused by hypertrophy of the sebaceous glands, soft tissues and blood vessels of the nasal tip. If large, it can lead to obstruction of the nares. Misdiagnosis by assuming that the bulbousness is due to the underlying nasal cartilage may make the surgeon excise nasal cartilage instead of the soft tissues, leading to an abnormal shape of the nasal tip. Rhinophyma is usually treated by direct excision with a scalpel or by dermabrasion, but laser excision or cryotherapy can be used. Great care must be taken not to excise or dermabrade too deeply or else the area will heal slowly and by secondary intention, leading to unsightly scarring. If the patient develops an infection in the excised area, deepening of the skin loss may occur, leading to additional scarring which the patient may find unacceptable. Full thickness excision of all the rhinophymatous tissue followed by skin grafting has been advocated in the past but this is not considered now to be an acceptable procedure because of the extensive resultant scarring.
Phymatous (Subtype 3) Rosacea
Frank C. Powell, Jonathan Wilkin in Rosacea: Diagnosis and Management, 2008
The main conditions which should be considered when a patient presents with progressive nasal swelling are shown in Table 2. Lupus pernio (sarcoid of the nose) causes a swelling and distortion of the nose that closely mimics and that may be misdiagnosed as rhinophyma. Careful inspection of the skin in these patients shows a shiny appearance to the skin surface. The large follicular openings containing oxygenated sebum that are the features of rhinophyma are absent. The nose in patients with lupus pernio often has a deep red or a purplish color (Fig. 11), while in patients with glandular rhinophyma, the normal flesh color or a minor degree of erythema of the nose is typically seen. Palpation of the nose reveals a firm, slightly indurated consistency in lupus pernio. In patients with glandular rhinophyma the swollen nose feels softer. The use of dioscopy (pressing a glass slide or transparent plastic implement firmly on the affected skin surface) reveals the characteristic “apple jelly nodules” in lupus pernio. These represent the non-caseating dermal granulomas that are the histologic hallmark of this disorder. The diagnosis of sarcoid should be confirmed by a skin biopsy, which typically shows the dermal granulomas with little surrounding inflammation (sometimes called “naked granulomas”). Other appropriate investigations (chest X-ray, pulmonary function studies, ocular examination, etc.) should be carried out if the diagnosis is confirmed to determine if there is multisystem involvement and referral to an appropriate specialist as required.
Paper 2
Aalia Khan, Ramsey Jabbour, Almas Rehman in nMRCGP Applied Knowledge Test Study Guide, 2021
Which of the following statements is false concerning acne rosacea? May present with recurrent facial flushing.Rhinophyma is a complication.Affects women more than men.Comedones are a feature.More common in fair-skinned people.
Treatment of rhinophyma with the Versajet™ Hydrosurgery System and autologous cell suspension (ReCELL®): A case report
Published in Journal of Cosmetic and Laser Therapy, 2018
Yıldız K., Kayan B. R., Dulgeroglu T., Guneren E.
Rhinophyma is considered to be the most severe expression of acne rosacea for which surgery is the mainstay of treatment. The word rhinophyma is derived from Greek words “rhis” meaning nose and “phyma” meaning growth (1). Rhinophyma is a glandular form of acne rosacea affecting the nose, in which the sebaceous glands hyperplasia to such an extent that the nose becomes bulbous and lobulated. This was once thought to be an unfounded association with heavy alcohol consumption. There is a male to female ratio of about 12:1, although acne rosacea is three times common in women than in men (2).
Use of laser therapy in the treatment of severe rhinophyma: a report of two cases
Published in Journal of Cosmetic and Laser Therapy, 2019
Adam Borzęcki, Monika Turska, Beata Strus-Rosińska, Agnieszka Sajdak-Wojtaluk
Most frequently, rhinophyma affects the nose, but may also locate within the chin/jaw (gnathophyma), forehead (metophyma), ear (otophyma), or eyelid (blepharophyma). Factors that may lead to the development of this disease include vascular abnormalities, endocrine disorders, and inflammation of hair follicles in the skin. Most experts believe that the coexistence of Helicobacter pylori infection does not play a role in the etiology of rhinophyma and the disease has a primary inflammatory etiology.
Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction
Published in Ocular Immunology and Inflammation, 2019
Dilay Ozek, Özlem Evren Kemer, Ferda Artüz
Generally, women are more often affected than men. Subtype I (ETR) is found to be most prevalent, followed by subtype II (PPR). Rhinophyma is seen mostly in men over 40 years of age.10 Disease onset is usually between the third and fifth decades of life, but manifestations can occur throughout life course.11