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Rinofima: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Rhinophyma (greek, rhis, rhinos nose + phyma outgrowth) (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
The cause of rhinophyma
Rhinophyma is the result of a skin disease of demodicosis caused by a microscopic mite demodex. Contributing factors are adverse environmental conditions, alcoholism, chronic diseases of the gastrointestinal tract, endocrine diseases, chemotherapy, autoimmune diseases. Important for the development of rhinophyma are unfavorable environmental conditions: dustiness and high humidity, rapid temperature changes, frequent hypothermia.
Pathogenesis of rhinophyma
The skin at the site of the lesion becomes inflamed and without proper treatment for many years the patient is diagnosed with roeacea, perioral dermatitis or acne.
The disease is often chronic, sluggish type. In such cases, demodicosis progresses and a rough "scar tissue" is formed in the skin. The face is covered with sores, abscesses, becomes earthy-gray in color. Most of all, the nose is struck, which in time begins to resemble a huge purple or dark red growth.
With rhinophyma, the nose slowly deforms for several years, then the current sharply accelerates and the nose becomes tuberous, blue-crimson and dark red, and sometimes even purple. These changes primarily affect the nose and cheeks, less often the chin, forehead and auricles, created a pronounced disfiguring effect.
Symptoms of Rhinophyma
Over time, subject to chronic progredient current, 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 fibro-angiomatous form, the nose as a result of hypertrophy of all skin elements increases uniformly in size, but does not lose its configuration. Due to the fact that the hypertrophied skin of the nose is rich in blood vessels, it acquires a bright red color.
When the glandular form on the nose formed pineal tumors, and as the development of knolls and knots merge into huge growths, which greatly obeobrazhivaet and deforms the nose. The nodes are soft, cyanotic in color. The mouth of the sebaceous glands is enlarged, from them, with light pressure, the contents that have a fetid odor are released. Nodes usually not ulcerated, sometimes associated with pyogenic infection, patients complain of soreness 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 corresponds to the cyanotic-violet color of the nose skin, a large amount of telangiectasia, hyperplastic sebaceous glands, which eventually changes the shape of the nose, and the skin acquires a small-hummocky appearance.
With actinic form, the nose increases evenly, gradually becomes brownish-cyanotic, and telangiectasias are localized mainly on the wings of the nose. The pores on the skin are dilated, and there are no pustules.
[Diagnosis of rhinophyma
Laboratory research
The histological examination is performed. With fibro-angiomatous form, vasodilation and inflammatory phenomena predominate, while hyperplasia of sebaceous glands is less pronounced. In the case of glandus, the process is caused by the powerful hyperplasia of the follicles of the sebaceous glands, as well as the hyperplasia of the connective tissue and the expansion of the blood vessels. At the heart of the fibrous form is diffuse hyperplasia of the predominantly connective tissue. Pathohistological pattern of actinic rhinophyma is characterized mainly by an increase in the number of elastic fibers.
Instrumental research
For the diagnosis of rhinophyma, the use of instrumental methods of investigation is not required.
Differential diagnosis of rhinophyma
Rhinophymus is differentiated with reticulosarcomatosis and leprosy.
Indications for consultation of other specialists
Consultation of a dermatologist and oncologist is indicated.
What do need to examine?
How to examine?
Treatment of rhinophyma
The goals of rhinophyma treatment
Elimination of cosmetic defect, restoration of normal function.
Indications for hospitalization
Conducting surgical methods of treatment.
Non-medicamentous treatment of rhinophyma
Electrocoagulation is used to destroy telangiectasias, papular and papular-pustular elements. Long-wave lasers are also used to destroy telangiectasias.
Medicinal treatment of rhinophyma
Carried out taking into account the stage of the disease. At the initial stages, drugs that improve the microcirculation of the skin, eliminate digestive disorders, use hormone therapy when the disease progresses. Locally use resorcinic, boric and tannic lotions, phytomass "Antineoderm SA". It is rational combination of surgical intervention with the reception of isotreticoin, which will lead to prolonged remission.
Surgical treatment of rhinophyma
They use electroscale, laser surgery, dermabrasion. With dermabrasion, the epidermis and papillary layer of the dermis are removed. In places where the removed elements are localized, an even wound surface is created, with the same smooth epithelization. As a result, a surface scab forms, which after 10-14 days heals, leaving behind a much thinner and better formed skin. Immediately after healing, the nose may turn red, but gradually it acquires a normal color. As a result, the appearance of the patient in many cases is significantly improved.
At sites of large sizes, plastic operations are performed. Reforming of the cartilage and bone subject does not solve the problem, it is in the skin itself and the sebaceous glands. Under local anesthesia or under anesthesia, the hypertrophied areas of the skin are cut with the sharp scalpel to the full depth of the thickening (in some cases the thickness of the skin with rhinophyma reaches a centimeter), followed by abrasion and the desired shape. On the wound surface, you can transplant the epidermis by Tirsch or apply a balsamic bandage. In the process of healing, the epidermal covering of the wound surface occurs from the deep sections of the ducts of the sebaceous glands, which always remain after the thickened layer of skin is cut off; while gross scars are not formed.
Apply wedge-shaped excision of affected tissues with subsequent suturing, subcutaneous excision of proliferation of connective tissue with U and T-shaped skin incisions, layered decortication with removal of hypertrophied skin and connective tissue growths and partial preservation of sebaceous glands, deep decortication consisting in complete removal of all nodes ,
Further management
In the early stages of the disease, the prevention and treatment of acne, the refusal to use alcohol, the exclusion of physical and chemical factors of occupational hazards.
Prevention of rhinophyma
It is not recommended to stay in the sun for a long time, avoid overcooling, work in high temperature rooms, visit the sauna, it is important to follow a diet with limited acute and smoked food, alcohol: timely treatment of acne, diseases of the gastrointestinal tract (dysbiosis).