Resolved question:
Dear Dr, For over a year my nose has been gradually increasing in size, it is now swollen significantly, by more than a third. It has thickened. The nasal tip has softened, become uneven and rounded. Recently Dr DSS suggested Rhinophyma. I think i may have this condition aswell as undiagnosed Phymatous Rosacea since a kid. 1)Is there an effective biopsy for Rhinophyma? 2)During the earlier stages of my swelling i did see an ENT Dr. The only thing he did was insert a tube up my nostrils (with a mirror attached to the other end) and conclude that this is not a disease. Could Rhinophyma be missed this way? 3)Could Atopic Eczema (which i have) co-exist with Rosacea? 4)Please read my following symptoms (or lack of) and let me know if it could still be Rhinophyma?; >No papules. >pink tip, not red. >wider nose. >internally the nose is more spacious. >stretchier nose. >the nose can now be pressed down more. Best Regards.
Submitted:
4 Days
Category:
ENT Specialist
Hello,
Thank you for your consult at DoctorSpring.com.
You are suffering from increasing in size of nose, with soft , uneven, pink and rounded tip. Your Nasal endoscopy test was normal.
Rhinophyma is a variant of rosacea. So not much confusion in diagnosis. So with present clinical presentation your diagnosis is rhinophyma only.
Symptoms of rosacea may overlap with atopic eczema.
Surgical treatment is required most of the time. Same time specimen can be sent for biopsy.
Surgical treatment include electrosurgery or laser excision or ablation or cryosurgery. (Medicines like isotretenoin can be used in early stage of disease).
You can improve the appearance , but may not get the perfect nose. But you can debulk or decrease the size of nose by any of these method, can be decided by your cosmetic surgeon.
Summary
• To get opinion from cosmetic surgeon.
• Biopsy can be sent following excision or surgical ablation.
Hope this helps. Please feel free to ask if you have any further queries.
Thank you
Regards
Dr. Sunil Jalan
MBBS, DLO,MS(ENT), DNB,DAA
Dear Dr Sunil Jalan,
Thank you for that.
I have a few questions concerning the available treatment options that you mentioned for
Rhinophyma, and a small clarification.
1)You mentioned that medicines can be used in the early stages. My nose has been increasing in size for 1-2 years, and looks about over a third the original size.
(a)Could this be considered early stages?
(b)If not, then will medicines now be of no benefit?
2)Out of the 4 surgical treatment options that you highlighted for Rhinophyma, which one of them is considered the most;
(a)Effective?
(b)Safest?
(c)Cheapest? (I live in the UK, but i'm sure it will be a similar matter around the world)
(d)Easiest/Quickest?
3)When you said that the 'symptoms of Rosacea may overlap with Atopic Eczema', did you mean by that existing together?
Best Regards.
Hello,
Thank you for the follow-up,
Medical treatment will help mainly for acne part, it includes isotreatoin and antibiotic, it may help you but has to be decided by your cosmetic surgeon / dermatologist.
Among the surgical options I believe scalpel excision and electrocuatry is best but again it depends on comfort and experience of your cosmetic surgeon. There is not much difference in results with diff techniques. If your cosmetics surgeon is more experienced with CO2 laser, then he will give best result with that. All methods are safe and almost same cost.
Atopic eczema is a different condition but it has similar presentation, so some time misdiagnosed.
Hope this helps
Regards
Dr. Sunil Jalan