While the ravages of subtype 3 (phymatous) rosacea have been well documented throughout history, today a multitude of options are available to restore a red, swollen or bumpy nose (rhinophyma) to normal appearance.

Although rosacea was not identified as a distinct medical disorder until the early 20th century, its existence has long been recorded in arts and literature, from the bumpy nose of the “Old Man and a Boy” by Ghirlandaio in 1490 – a vivid representation of rhinophyma – to the red faces of subtype 1 rosacea depicted in “Dutch Merrymakers at Shrovetide,” by Frans Hals in 1617.

Early candid photographs show that the famed financier J.P. Morgan was afflicted with rhinophyma, including one in which he is brandishing an umbrella or walking stick to discourage the photographer, as his official picture was altered to correct the image of his nose, according to an article by Drs. Warren Dotz and Neil Berliner in the American Journal of Dermatopathology.¹

“It’s interesting that even one of the richest men in the world was terribly embarrassed by his rosacea and wanted a formal picture retouched to erase its appearance,” said Dr. Dotz. “In the early 20th century, there was little he could do about it.”

Phymatous rosacea may include thickening skin, irregular surface nodularities and enlargement. Rhinophyma – involvement of the nose – is most typical, but phymatous rosacea may also occur in other locations. Patients with this subtype also may have enlarged pores, and small visible blood vessels known as telangiectases may be present. This subtype has frequently been observed after or in combination with flushing and bumps and pimples.

“Fortunately today, dermatologists have ways to control this potentially life-disruptive condition,” said Dr. Dotz.

With the use of medications, avoidance of rosacea-inducing trigger factors and laser therapies, patients can improve their lives and their self-image, he said. Rosacea therapy may be appropriate early, when there are dilated pores, and oral isotretinoin, used to treat severe acne, has been demonstrated to decrease nasal volume, especially in those with less advanced disease.

However, more severe rhinophyma may still be treated with surgical therapy, including lasers, cryosurgery, radiofrequency ablation, electrosurgery, a heated scalpel, electrocautery and tangential excision, combined with scissor sculpturing, skin grafting or dermabrasion. Often a CO2 or erbium:YAG laser may be used as a bloodless scalpel to remove excess tissue and recontour the nose to a normal appearance, and fractional resurfacing may be of value in mild cases.

“Thanks to modern medical technology, the effects of rhinophyma are undoubtedly seen less often today, as they no longer must be a permanent aspect of anyone’s appearance,” Dr. Dotz said.

Reference:

1. Dotz W, Berliner N. Rhinophyma: a master’s depiction, a patron’s affliction. Am J Dermatopathol 1984;6:231-235.