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Rhinophyma: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Rhinophyma (Greek rhis, rhinos nose + phyma growth) (wine nose, pineal nose) is an inflammatory disease of the skin of the nose, characterized by hypertrophy of all its elements (connective tissue, blood vessels and sebaceous glands), enlargement and disfigurement of the nose.
ICD-10 code
L71.1 Rhinophyma
Cause of Rhinophyma
Rhinophyma is a consequence of the skin disease demodicosis, caused by the microscopic mite demodex. Contributing factors include unfavorable environmental conditions, alcoholism, chronic gastrointestinal diseases, endocrine diseases, chemotherapy, autoimmune diseases. Unfavorable environmental conditions are important for the development of rhinophyma: dust and high humidity, sudden changes in temperature, frequent hypothermia.
Pathogenesis of rhinophyma
The skin at the affected site becomes inflamed and without proper treatment for many years the patient is diagnosed with rosacea, perioral dermatitis or acne.
The disease is often chronic and sluggish. In such cases, demodicosis progresses and rough "scar" tissue forms in the skin. The face becomes covered with ulcers, abscesses, and becomes an earthy-gray color. The nose is most affected, which over time begins to resemble a huge purple or dark red growth.
With rhinophyma, the nose slowly deforms over several years, then the progression accelerates sharply and the nose becomes bumpy, blue-purple and dark red, and sometimes even purple. These changes primarily affect the nose and cheeks, less often the chin, forehead and ears, creating a pronounced disfiguring effect.
Symptoms of Rhinophyma
Over time, under the condition of a chronic progressive course, the pathological process leads to the formation of inflammatory nodes, infiltrates and tumor-like growths due to progressive hyperplasia of connective tissue and sebaceous glands and persistent vasodilation.
In the fibrous-angiomatous form, the nose, as a result of hypertrophy of all skin elements, uniformly increases in size, but does not lose its configuration. Due to the fact that the hypertrophied skin of the nose is rich in vessels, it acquires a bright red color.
In the glandular form, cone-shaped tumors form on the nose, and as they develop, the bumps and nodes merge into huge growths, which greatly disfigures and deforms the nose. The nodes are soft and bluish in color. The openings of the sebaceous glands are enlarged, and when lightly pressed, they release contents that have a foul odor. The nodes are usually not ulcerated, sometimes a purulent infection joins in, and patients complain of pain and itching. Quite often, due to inflammatory processes in the paranasal areas of the skin, rhinophyma is accompanied by blepharitis and conjunctivitis.
The fibrous form is characterized by a bluish-purple color of the skin of the nose, a large amount of telangiectasia, hyperplastic sebaceous glands, which ultimately changes the shape of the nose, and the skin takes on a finely bumpy appearance.
In the actinic form, the nose increases in size uniformly, gradually becoming brownish-blue, and telangiectasias are localized mainly on the wings of the nose. The pores on the skin are enlarged, and there are no pustules.
[ Diagnosis of rhinophyma
Laboratory research
A histological examination is performed. In the fibrous-angiomatous form, vascular dilation and inflammatory phenomena predominate, while sebaceous gland hyperplasia is expressed to a lesser extent. In the glandular form, the process is caused by powerful hyperplasia of sebaceous gland follicles, as well as hyperplasia of connective tissue and dilation of blood vessels. The fibrous form is based on diffuse hyperplasia of predominantly connective tissue. The histopathological picture of actinic rhinifema is characterized mainly by an increase in the number of elastic fibers.
Instrumental research
To diagnose rhinophyma, the use of instrumental research methods is not required.
Differential diagnosis of rhinophyma
Rhinophyma is differentiated from reticulosarcoma and leprosy.
Indications for consultation with other specialists
Consultation with a dermatologist and oncologist is recommended.
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Treatment of rhinophyma
Goals of Rhinophyma Treatment
Elimination of cosmetic defects, restoration of normal function of the nose.
Indications for hospitalization
Carrying out surgical treatment methods.
Non-drug treatment of rhinophyma
Electrocoagulation is used to destroy telangiectasias, papular and papulopustular elements. Long-wave lasers are also used to destroy telangiectasias.
Drug treatment of rhinophyma
Conducted taking into account the stage of the disease. At the initial stages, drugs are used that improve skin microcirculation, eliminate digestive disorders, and as the disease progresses, hormone therapy is used. Resorcinol, boric and tannin lotions, phytomae "Antineoderm S-A" are used locally. A combination of surgical intervention with isotreticoin is rational, which will lead to long-term remission.
Surgical treatment of rhinophyma
Electroscalpel, laser surgery, and dermabrasion are used. Dermabrasion involves removing the epidermis and papillary layer of the dermis. In the areas where the removed elements are located, a smooth wound surface is created with the expectation of the same smooth epithelialization. As a result, a superficial scab is formed, which heals in 10-14 days, leaving behind significantly thinner and better formed skin. Immediately after healing, the nose may be red, but gradually it acquires a normal color. As a result, the patient's appearance in many cases improves significantly.
In case of large nodes, plastic surgery is performed. Reshaping the underlying cartilage and bone does not solve the problem; the problem is in the skin itself and the sebaceous glands. Under local anesthesia or general anaesthesia, the hypertrophied areas of the skin are cut off with a sharp scalpel to the full depth of the thickening (in some cases, the thickness of the skin in rhinophyma reaches a centimeter) with subsequent abrasion and giving the desired shape. Epidermis can be transplanted to the wound surface according to Thiersch or a balsamic dressing can be applied. During the healing process, the epidermis covers the wound surface from the deep sections of the sebaceous gland ducts, which always remain even after the thickened layer of skin is cut off; in this case, coarse scars are not formed.
They use wedge excision of affected tissues with subsequent suturing, subcutaneous excision of connective tissue growths using U- and T-shaped skin incisions, layered decortication with removal of hypertrophied skin and connective tissue growths and partial preservation of the sebaceous glands, deep decortication, which consists of complete removal of all nodes,
Further management
In the early stages of the disease, prevention and treatment of acne, abstinence from alcohol consumption, elimination of physical and chemical factors of occupational hazard.
Prevention of rhinophyma
It is not recommended to stay in the sun for a long time, avoid hypothermia, work in high-temperature rooms, visits to the sauna, It is important to follow a diet with restrictions on spicy and smoked foods, alcohol: timely treatment of acne, gastrointestinal diseases (dysbacteriosis).