CME Rhinophyma: Review and Update

Rhinophyma may have been first recognized in ancient Greece and Arabia.1,2 Elliott et al. and Matton et al. credit Hebra with naming the disease in the mid-nineteenth century.3,4 The name is derived from the Greek rhis, for nose, and phyma, meaning growth. Many imaginative terms have been used to describe the erythematous, hypertrophied, and inflamed nose that typifies rhinophyma. In the past, the deformity has been compared with tuberous vegetables as well as to animal snouts. The terms “rum blossom” and “whiskey nose” have permeated our society. These terms, and their association with famous persons such as W. C. Fields, have helped to perpetuate the common association of rhinophyma with alcoholism. Although the facial flushing caused by vasoactive substances such as caffeine and alcohol may exacerbate the condition, rhinophyma is more likely a severe form of acne rosacea. Virchow is credited by Wiemer as having correctly associated rhinophyma with acne rosacea in 1846.1 Over the last 40 years, numerous reports have supported the progression of rosacea to acne rosacea and the final manifestation of rhinophyma.1,5–7 As a result, medicines that have been helpful in the treatment of rosacea are now being used to augment the predominantly surgical approach to rhinophyma. In this article, we present a discussion on the pathology, clinical manifestations, and described treatment options for rhinophyma. We also discuss the differential diagnosis with emphasis on conditions that can mimic rhinophyma. We offer our preferred approach to rhinophyma that incorporates medical management and a surgical plan guided by preoperative standardized aesthetic facial and nasal analysis.