Rhinophyma: Its Treatment and Complications

Abstract

The treatment for rhinophyma, in spite of its definite pathologic changes, is far from uniform. This may be accounted for by the fact that rhinophyma as a progressive developing deformity of the skin is usually observed in its early stages by the dermatologist and only later, after the tumor has increased considerably in size, does the patient seek the advice of the surgeon. Hence, two methods of treatment prevail, namely, the conservative dermatologic and the surgical. An adequate treatment for rhinophyma must depend entirely on its anatomicopathologic structure, which I shall discuss. PATHOLOGIC ANATOMYThe original condition of the skin is acne rosacea, which slowly develops into rhinophyma, usually invading the inferior and anterior parts of the nose, respecting the free border of the alae nasi and diminishing in size from below upward, rarely extending beyond the glabellar region and the lateral border of the nose. The irregular elevations of the tumor are separated by fissures in which sebaceous masses are accumulated. The nose takes on a more or less violet hue spotted by dilated veins. Regardless of the proportion and aspect of the tumor, the lesions are invariably confined to the soft tissues of the nose, the nasal bones, the cartilage and the nasal mucous membrane remaining intact. The modification of the sebaceous glands plays an important part in the pathologic condition. These glands are greatly increased in number and become abnormally developed in size. The subcutaneous tissue and the dermis are the seat of a chronic inflammatory process, but the epidermis generally remains uninvolved. When fully developed, this condition constitutes a repelling disfigurement, relief from which is eagerly sought for.The following case report is of interest because it involves the problem of treatment for the severe complications which follow a seemingly harmless but dangerous procedure used in the treatment for rhinophyma. In view of the advanced age of the patient, the reconstruction of the resulting nasal defect is of additional interest.

Surgical Treatment of Rhinophyma

“…On the basis of the sebaceous gland pathology, the lesion has been termed "sebaceoma nasi" or "adenoma sebaceum." Similar pathologic Submitted for publication Dec. 5,1960. From the Department of Otorhinolaryngology, Mercy Hospital.…”

Surgical Treatment of Rhinophyma

“…On the basis of the sebaceous gland pathology, the lesion has been termed "sebaceoma nasi" or "adenoma sebaceum." Similar pathologic Submitted for publication Dec. 5,1960. From the Department of Otorhinolaryngology, Mercy Hospital.…”

Rhinophyma

“…This may be accomplished by use of either cold scalpel 14>16,i9,2o or "eiectric knife." 15 In the latter modality, the elec¬ trode may be a sharp one or a loop. When the scalpel is used, the growth may be re¬ moved by paring in gradual stages; or the lesion is circumscribed by a deep incision extending through the full cutaneous depths and then the growth is decorticated en masse.…”

Surgical Treatment of Rhinophyma

“…On the basis of the sebaceous gland pathology, the lesion has been termed "sebaceoma nasi" or "adenoma sebaceum." Similar pathologic Submitted for publication Dec. 5,1960. From the Department of Otorhinolaryngology, Mercy Hospital.…”

Rhinophyma

“…This may be accomplished by use of either cold scalpel 14>16,i9,2o or "eiectric knife." 15 In the latter modality, the elec¬ trode may be a sharp one or a loop. When the scalpel is used, the growth may be re¬ moved by paring in gradual stages; or the lesion is circumscribed by a deep incision extending through the full cutaneous depths and then the growth is decorticated en masse.…”

Surgical Treatment of Rhinophyma

“…On the basis of the sebaceous gland pathology, the lesion has been termed "sebaceoma nasi" or "adenoma sebaceum." Similar pathologic Submitted for publication Dec. 5,1960. From the Department of Otorhinolaryngology, Mercy Hospital.…”

Rhinophyma

“…This may be accomplished by use of either cold scalpel 14>16,i9,2o or "eiectric knife." 15 In the latter modality, the elec¬ trode may be a sharp one or a loop. When the scalpel is used, the growth may be re¬ moved by paring in gradual stages; or the lesion is circumscribed by a deep incision extending through the full cutaneous depths and then the growth is decorticated en masse.…”