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At least 19 recordsLinked to original sources

PubMed2002

Further evidence for the role of fibrosis in the pathobiology of rhinophyma.

Recent evidence suggests that fibrosis may play an important role in the pathobiology of rhinophyma. The fibrogenic cytokine transforming growth factor (TGF)-beta2 has been reported to be up-regulated in rhinophyma tissue. Of the three common isoforms of TGF-beta, TGF-beta1 and TGF-beta2 are considered fibrogenic, whereas TGF-beta3 has antiscarring properties. To provide further evidence for the role of fibrosis in the pathobiology of rhinophyma, specimens from 8 patients with rhinophyma were compared with nine specimens of normal nasal skin. Immunohistochemistry was used to compare intensity levels of TGFbeta1 and TGFbeta3 proteins, and quantitative reverse transcription-polymerase chain reaction was used to determine messenger ribonucleic acid (mRNA) expression levels of TGFbeta1 and TGFbeta3. TGF-beta1 was elevated significantly in rhinophyma tissue (p < 0.001), whereas TGF-beta3 was no different in the rhinophyma specimens compared with normal nasal skin (p = 0.06). TGFbeta1 mRNA expression was five-fold higher in rhinophyma tissue compared with normal skin (p < 0.001). The mRNA expression of TGF-beta3 was the same for both pathological and normal tissue (p < 0.09). These data, together with previously published observations, present further evidence that fibrosis mediated by the fibrogenic cytokines TGFbeta1 and TGFbeta2 play a role in the pathobiology of rhinophyma and suggest a means of treatment by neutralizing or down-regulating these cytokines.

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PubMed2000

Overexpression of transforming growth factor beta-2 and its receptor in rhinophyma: an alternative mechanism of pathobiology.

Proliferative scarring is one of the clinical features of rhinophyma. The following study was undertaken to test the authors' hypothesis that fibrosis might also play an important role in the pathobiology of rhinophyma. The rhinophyma specimens were obtained from 5 white men (mean age, 67.8 years). Normal skin biopsies near benign facial lesions from 5 additional white men of similar age were obtained to serve as controls. Peroxidase-labeled immunohistochemical staining was performed in the rhinophyma and normal skin specimens for the presence of transforming growth factor (TGF) beta-2 and/or TGF-beta II receptor. Histological slides were then measured for the intensity of staining for TGF-beta2 and TGF-beta II receptor using a computer-aided imaging system. The dermis of the rhinophyma tissue displayed stronger immunoreactivity of TGF-beta2 (p = 0.014) and TGF-beta II receptor (p = 0.006) compared with the normal skin. The results of this study demonstrate the overexpression of the fibrogenic protein TGF-beta 2 and TGF-beta II receptor in rhinophyma tissues. These findings support the authors' hypothesis that fibrosis may also play an important role in the pathobiology of rhinophyma.

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PubMed1994

Rhinophyma in Japan.

BACKGROUND: Rhinophyma is an end stage of acne rosacea. It results in a large nose due to a proliferation of sebaceous glands and fibrous tissue. Many cases of rhinophyma have been reported in the Western world; however, in Japan, rhinophyma has been an uncommon disease. METHODS: We present two patients associated with rhinophyma who were treated by cross-shaped full-thickness excision followed by direct closure and compare the rhinophyma in Japan with that in the West. RESULTS: To date, only 20 rhinophyma cases including our 2 cases have been reported in Japan. Epidemiologic factors of rhinophyma between the West and Japan do not differ except for location, malignancy and surgical treatment. CONCLUSIONS: In Japan, almost all cases are located on the lower half of the nose, treated by full-thickness excision followed by application of either skin grafts or direct closure. None have been malignant.

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PubMed2002

Excision of rhinophyma with a laser scanner handpiece--a modified technique.

Rhinophyma is a slowly progressive, benign dermatological disorder of the tip of the nose. The most widely accepted theory is that rhinophyma is the end stage result of chronic acne rosacea. The primary reason for excision of rhinophyma is cosmetic deformity. However, nasal obstruction may present, as rhinophyma may obstruct nasal vestibules. Surgery is the treatment of choice for rhinophyma. Medical therapy has not given satisfactory results. The surgical treatment modalities are divided into two main groups. The first is complete excision, with primary closure for small lesions, or skin grafting for large lesions. The second group includes incomplete excision followed by re-epithelialization from the remaining glandular epithelium. The carbon dioxide (CO2) laser has been advocated for excision of rhinophyma. Newer instrumentation, such as Swiftlase and SurgiTouch (ESC Sharplan) or Ultrapulse (Coherent) is more effective in vaporization and carbonization resulting in better hemostasis (Ries and Speyer, 1996). In this report, 7 patients with rhinophyma treated with the Swiftlase are reviewed. The surgical technique, the complications and the follow-up are discussed.

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PubMed2003

[Surgical treatment of rhinophyma with the ultrasonic scalpel (Ultracision Harmonic Scalpel)].

BACKGROUND: There are multiple surgical approaches to the treatment of rhinophyma. Because of the exceptional vascularity of the nose, traditional surgical approaches to the management of rhinophyma are fraught with persistent intraoperative hemorrhage. Hemorrhage that is controlled with electrocautery or laser by a combination of excision of rhinophymatous tissue and simultaneous hemostasis invariably damages cartilage by thermal injury. The UltraCision Harmonic Scalpel achieved a tissue dissection with a simultaneous hemostasis and only minimal thermal tissue injury. To this date, in Europe no studies have been published on the use of the Ultracision Harmonic Scalpel in the surgical treatment of rhinophyma. PATIENTS AND TREATMENT: 6 patients had surgical treatment of rhinophyma with the UltraCision Harmonic Scalpel. The objective of the study was therefore to analyse the handling indication, the efficiency of intra- and postoperative hemostasis, the wound healing, the postoperative pain and the histologic results of tissue resections. RESULTS: Because of the effective intraoperative hemostasis supplementary hemostasis was not required in any examined patient. The efficient hemostasis and the tactile experience of the UltraCision Harmonic Scalpel enabled an accurate sculpting of the nose. Postoperative pain sensation was minimal. Wound healing was uneventful in all cases. Postoperative reepithelialization occurred within 28 days. Delayed complications like scarring did not occur within a median follow - up of 13 month. Histopathological evaluation was possible in all cases. CONCLUSION: The UltraCision Harmonic Scalpel offers a surgical treatment of rhinophyma with efficacious intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. Based on its mechanical function, the UltraCision Harmonic Scalpel has only a little thermal effect on neighbouring tissues and a good tactile experience that enables a controlled tissue resection. The UltraCision Harmonic Scalpel combines the advantages of tissue dissection and simultaneous hemostasis with the controlled handling of the traditional scalpel in rhinophyma surgery.

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PubMed2004

Rhinophyma: dispelling the myths.

Rhinophyma is a relatively common condition in the west of Scotland. The Canniesburn Plastic Surgery Unit receives 12 to 13 new patients per year for surgical treatment. The reported incidence of simultaneous carcinoma in the setting of rhinophyma is on the order of 15 to 30 percent. There are conflicting reports about the association between alcohol and rhinophyma in the literature, and these are supported with little or no statistical evidence. Retrospective epidemiologic data on 45 cases of rhinophyma are presented. An audit of case notes was performed to examine histology and also alcohol consumption in these cases. The authors found no coincidental malignancies at the time of surgery, which is contrary to many previous publications. The alcohol consumption of the rhinophyma cases was compared with that of a control group that consisted of 48 men presenting for blepharoplasty. The series did not demonstrate a positive association between alcohol and rhinophyma when compared with a similar cohort of patients presenting for blepharoplasty surgery (p > 0.20) or with statistics available from the Scottish Health Survey.

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PubMed2002

Surgical management of rhinophyma: report of eight patients treated with electrosection.

BACKGROUND: Rhinophyma is the end stage of rosacea, affecting almost exclusively male patients, characterized by a progressive deformity in nasal shape. Depending on the extent of the deformity, rhinophyma may distort the appearance of those affected and patients may become psychosocially disabled. OBJECTIVE: To present the results of electrosurgical technique of sequential delamination with a slightly damped current in rhinophyma. METHODS: Eight healthy male patients affected by moderate to severe rhinophyma were recruited. A radiofrequency electrosurgical unit was used in the cut/coagulate mode at 40 W (3.8 MHz) to remove thin layers of tissue until the nose shape was re-created. RESULTS: All patients achieved acceptable cosmetic results. Cutaneous reepithelialization was achieved at day 14 after surgery. Erythema subsided within 4-8 weeks and healing was complete with minimal scar formation by 8-10 weeks. None of the patients developed hypertrophic scarring and hypopigmentation was minimal. CONCLUSION: Electrosection is as effective as laser treatments and less expensive. Although living in a laser era, electrosurgical remodeling of the nose is a good alternative for the treatment of rhinophyma.

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PubMed2002

Excision of rhinophyma with high-frequency electrosurgery.

BACKGROUND: Rhinophyma is an uncommon progressive disfiguring process of the lower nasal region that most commonly affects middle-aged white men. It is characterized by painless hyperplasia of the sebaceous and subcutaneous tissues, in the end stage, resulting in a bulbous nodular telangiectatic nose. Surgical modalities of treatment include electrosurgery, laser ablation, dermabrasion, cryosurgery, scalpel excision, and others. OBJECTIVE: We present two patients with rhinophyma who were treated with the Ellman Surgitron using high-frequency current. METHODS: Two patients with significant rhinophyma and associated subcutaneous abscesses underwent excision with the Ellman Surgitron using high-frequency electrosurgery with a wire loop. The sebaceous hypertrophy was shaved down to the level of the normal skin surface. RESULTS: This technique provided a quick, efficient, bloodless operative field with a good cosmetic result and pain-free postoperative recovery. Photographs were taken at regular intervals to document the healing process. CONCLUSION: The Ellman Surgitron uses high-frequency current to achieve a bloodless field in the treatment of rhinophyma. This enabled efficient and quick removal of hypertrophied tissue with a good cosmetic result and an essentially pain-free recovery. This radiofrequency device is well suited for the outpatient setting and offers advantages over the other modalities used to treat rhinophyma.

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PubMed2002

Rhinophyma: review and update.

LEARNING OBJECTIVES: After studying this article, the participant should be able to discuss: 1. Clinical features and anatomy of rhinophyma. 2. The etiology and epidemiology of rhinophyma. 3. Associated diagnosis that can complicate rhinophyma. 4. Common nonsurgical and surgical therapies for rhinophyma. 5. A safe and integrated treatment plan for the patient with rhinophyma.

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PubMed2006

Down-regulating causes of fibrosis with tamoxifen: a possible cellular/molecular approach to treat rhinophyma.

Fibrosis and proliferative scarring are prominent features of the severe forms of rhinophyma. Up-regulation of growth and fibroblast kinetics are hallmarks of fibrosis. Persistent overexpression or dysregulated activation of the fibrogenic isoforms of transforming growth factor beta (TGF-beta) is associated with the increased fibroblast function leading to fibrotic conditions such as rhinophyma. Tamoxifen, a synthetic nonsteroidal antiestrogen, can neutralize or down-regulate TGF-beta. Fibroblast-populated collagen lattices (FPCLs) were constructed from fibroblasts cultured from rhinophyma or normal nasal skin. One-half of each set of FPCLs was treated with Tamoxifen. Lattice contraction was serially measured over 5 days, and the supernatants of the cultures were analyzed for TGF-beta-2 by immunoassay. Tamoxifen significantly decreased fibroblast activity by decreasing contraction of the treated lattices (P < 0.05) and significantly decreased the production/secretion of TGF-beta-2 by rhinophyma fibroblasts (P < 0.001). These results suggest a possible new cellular/molecular approach to the treatment of the fibrotic varieties of rhinophyma.

Case-Control Studies↗

PubMed1999

Mohs' surgery as an approach to treatment of multiple skin cancer in rhinophyma.

BACKGROUND: Skin cancer arising within a rhinophyma is rare, less than would be expected from the coexisting chronic active inflammatory process. In rhinophyma, multiple coexisting tumours of different histologic types present an unusual challenge and have never been described in the literature. OBJECTIVE: The treatment approach to multiple tumours occurring in rhinophyma, utilizing Mohs' surgery, is reported and discussed. PATIENT: The case of a 64-year-old farmer with basal cell carcinoma, squamous cell carcinoma, and basosquamous carcinoma occurring in the setting of longstanding rhinophyma is described. CONCLUSION: Skin cancer, especially basal and squamous cell carcinoma, diagnosed simultaneously in a rhinophyma creates a challenge; the enlarged, inflamed, and hypertrophied tissue masks their margins. In our opinion, Mohs' micrographic surgery is the treatment of choice and should be primarily considered in view of the malignant potential of these tumours, as is shown by the substantial tumour extension in the case described.

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PubMed2005

[Rhinophyma--diagnosis and treatment].

The authors present four cases with rare disease--rhinophyma. These disease occurs mainly in males of middle and old age. It results from long-standing rosacea in some patients. Risk factors are blood vessels disorders, endocrinal abnormality, digestive tract disorder. In laryngological practice there are many methods of non-surgical treatment of rhinophyma. The aim of the treatment is to remove deformation and restore function of the nose and prevent the relapse of rhinophyma. Rhinophyma is removed with the epidermis and the wound is realest to self epithelisation in case of small changes, but in more severe cases of rhinophyma the wound needs to be covered by skin scalp.

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PubMedDate not supplied

Use of a dual-mode erbium:YAG laser for the surgical correction of rhinophyma.

Rhinophyma is a cosmetically deforming disorder characterized by nodular hypertrophy of the nasal soft tissue. Treatment of rhinophyma usually consists of laser ablation or surgical excision for correction of the associated tissue deformity. We describe 6 patients with mild to severe rhinophyma who were treated with a dual-mode erbium:YAG (Er:YAG) laser, which provides the advantages of controlled ablative energy for tissue reduction and excellent intraoperative hemostasis. Outcome measures included patient satisfaction, clinician observer ratings, and an assessment of complications, including scarring, pigment abnormalities, and postoperative bleeding. All patients were satisfied with their outcomes, and no complications were detected during follow-up. All treatment outcomes were rated as very good to excellent at a 3-month follow-up visit. The flexibility of the dual-mode Er:YAG laser provides both controlled ablation and hemostasis, making it an ideal laser for the surgical treatment of rhinophyma.

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PubMed1993

The treatment of rhinophyma. 'Cold' vs laser techniques.

OBJECTIVE: To compare laser surgery and sharp blade excision of rhinophyma. DESIGN: Retrospective study of 23 patients treated surgically for rhinophyma. SETTING: Four academic tertiary referral medical centers. PARTICIPANTS: All 23 patients had moderate or major rhinophyma. INTERVENTION: Sixteen patients had laser surgery. Seven patients had sharp blade excision. OUTCOME MEASURES: Length of the procedure, preservation of normal tissue, the need for skin grafting, intraoperative pain and discomfort, intraoperative bleeding, postoperative pain and discomfort, postoperative bleeding, complications, and end results (all listed in the literature as advantages of laser surgery). RESULTS: No difference in length of surgery, preservation of normal tissue, complications, postoperative pain, and end results. No need for skin grafting in both procedures. Less intraoperative and postoperative bleeding, easier and smoother procedure, and more comfortable postoperative care with laser surgery. CONCLUSIONS: Our results do not agree with most of the list of advantages attributed to laser rhinophyma surgery in the literature.

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PubMed1991

Spectrum of results after treatment of rhinophyma with the carbon dioxide laser.

Between 1986 and 1989, 30 patients with rhinophyma were treated with the carbon dioxide (CO2) laser at our institution. The duration of disease ranged from 1 to 20 years, and the duration of follow-up ranged from 1 to 4 years. All the patients were men, and all had fair skin (predominantly type I skin); their mean age was 63 years. Patients with minor and moderate rhinophyma were treated with CO2 laser vaporization only, whereas patients with major rhinophyma were treated sequentially with CO2 laser excision and then vaporization. A spectrum of long-term results is presented. Although dilated pores developed in many patients, no re-treatment with the CO2 laser was necessary. In one patient each, leukoderma, unilateral alar lift, and mild hypertrophic scarring developed. In general, use of the CO2 laser is effective for precise decortication of rhinophyma in an office-outpatient setting.

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PubMed2000

The clinicopathologic spectrum of rhinophyma.

We report the results of a clinicopathologic study of 17 patients with rhinophyma in different stages of evolution, with particular attention paid to the severe form of this disease. On the basis of clinical features, we identified 2 groups of patients: the first group (12/17 patients) included patients with the common form of rhinophyma, whereas the second one (5/17 patients) included patients with the severe form of the disease. There was no link between the clinical aspect and the duration of the disease. Microscopic examination of specimens obtained from the classic type of rhinophyma substantially showed the histopathologic features of fully developed rosacea, except for the presence of prominent sebaceous hyperplasia. The second group showed a very different histologic pattern displaying marked dermal thickness, absence of folliculosebaceous structures, sclerotic collagen bundles with large amounts of mucin, and spreading telangiectasia. The inflammatory infiltrate was inconspicuous, with numerous interstitial spindle and bizarre cells. Most of the interstitial cells were reactive to factor XIIIa. The severe form of rhinophyma shares many histologic characteristics with elephantiasis caused by chronic lymphedema.

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PubMed1998

Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities.

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously.

Anti-Bacterial Agents↗

PubMed1987

Methods and complications of rhinophyma excision.

For years cosmetic surgeons have sought methods of treatment of large rhinophyma. These include creation of flaps with excision of excess skin, dermabrasion, free-hand shave, and others. The CO2 laser has been used by itself, or in combination with other methods to vaporize the rhinophyma. Advantages of the the laser include hemostasis, better view of the tissues, thin layer-by-layer removal of the hyperplastic sebaceous glands, and careful shaping of the resection edges. Disadvantages include risk of facial burns and overabundant removal of tissue with cartilage exposure. We present a case of rhinophyma excision using the CO2 laser and the complication of excessive vaporization of the sebaceous tissue. Included is a discussion of other complications of laser excision of rhinophyma, possible methods of reconstruction, and a literature review.

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