Page 59 - Read Online

Walter et al. Unilateral rhinophyma

increasing vascular permeability. [10,11] postulated that it may have occurred unilaterally due
to localized factors such as sleeping on the affected
What exactly triggers the innate immune response is not ear, trauma or infection. [17] The etiology of unilateral
known but UV light, trauma and microorganisms such rhinophyma remains unknown, and possibilities include
as Demodex mites are thought to play a role. Demodex spontaneous or idiopathic asymmetric inflammation, or
mites, although common in the general population, a localized lymphedematous or inflammatory process,
are prevalent in up to 100% of rosacea patients. such as might result from localized infection or trauma.
[1]
The mites are thought to trigger an immune response, Our patient has healed well after electrosurgical
act as a vector for other bacterial pathogens and treatment and is pleased with his improvement.
block hair follicles. Additionally, smokers have been
[3]
found to have a higher risk of developing rosacea. [12] Authors’ contributions
Concept design: K.K. Reddy
The exact pathogenesis of the phymatous stage of Definition of intellectual content: K.K. Reddy, S. Walter
rosacea is also not well understood. It is postulated Literature search, data acquisition, data analysis: S.
to be a combination of the above factors in addition Walter, J. Ho
to alterations in blood flow via decreased dermal Manuscript preparation, editing, and review: S. Walter,
vasoactive intestinal peptide receptors. [13] In the severe J. Ho, S. Krueger, K.K. Reddy
variant of rhinophyma described by Aloi et al., they
[4]
hypothesize that the pathogenesis is similar to that of Financial support and sponsorship
lymphedema. They suggest that the severe fibroplasia
seen in this form of rhinophyma impairs lymphatic None.
drainage which leads to persistent edema and
destruction of adnexal structures. Over time, this fluid Conflicts of interest
collection stimulates further fibrosis via production of There are no conflicts of interest.
collagen and glycosaminoglycans.
Patient consent
The treatment for rhinophyma is approached in a The proper consent of the patient was taken for
different fashion compared to the other rosacea carrying out all the tests and treatment.
subtypes. Younger patients with early signs of
rhinophyma may respond well to oral isotretinoin, Ethics approval
but surgery remains the only definitive treatment The procedures followed were in accordance with
for those with advanced disease. [1,6,14,15] A surgical ethical standards of the responsible committee on
approach may include electrocautery, laser ablation, human experimentation. As an experiment was not
cryotherapy, dermabrasion, paring with a scalpel blade, performed, local institutional review board protocol
or a combination of these techniques to achieve an was not required.
optimal outcome. [14,15] Use of electrosurgery to excise
the rhinophyma can reduce bleeding. Preservation REFERENCES
[6]
of the sebaceous glands allows for adequate re-
epithelialization, and the excision should not extend 1. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology,
deeply enough to expose cartilage. [6,15] Skin grafts pathogenesis, and subtype classification. J Am Acad Dermatol
or local flaps can be used to cover the defect, or the 2004;51:327-41.
wound can be allowed to re-epithelialize spontaneously 2. Powell FC, Raghallaigh SN. Rosacea and related disorders. In:
within 2 weeks. Removing too much tissue can result Bolognia JL, Schaffer JV, Jorizzo JL. Dermatology. 3rd. Philadelphia:
in a smooth, shiny scar that does not match the rest 3. Elsevier Saunders; 2012. p. 561-70.
Tüzün Y, Wolf R, Kutlubay Z, Karakuş O, Engin B. Rosacea and
of the nose. [6,15] Laser ablation therapy is another rhinophyma. Clin Dermatol 2014;32:35-46.
option for treatment. One study evaluated 24 patients 4. Aloi F, Tomasini C, Soro E, Pippione M. The clinicopathologic
with rhinophyma who were treated with a 10,600-nm spectrum of rhinophyma. J Am Acad Dermatol 2000;42:468-72.
CO pulsed laser. They found that 79.1% had high 5. Tan J, Berg M. Rosacea: current state of epidemiology. J Am Acad
2
improvement, 16.7% had moderate improvement and Dermatol 2013;69:S27-35.
4.2% had low improvement, with minimal side effects. [16] 6. Roberts JO, Ward CM. Rhinophyma. J R Soc Med 1985;78:678-81.
7. Marks R, Harcourt-Webster JN. Histopathology of rosacea. Arch
Dermatol 1969;100:683-91.
Here we have presented what is, to our knowledge, 8. Gomaa AH, Yaar M, Eyada MM, Bhawan J. Lymphangiogenesis and
the first reported case of unilateral rhinophyma. [17] angiogenesis in non-phymatous rosacea. J Cutan Pathol 2007;34:748-
Why it appeared unilaterally is unclear. Interestingly, 53.
unilateral otophyma has been reported, and the authors 9. Smith JR, Lanier VB, Braziel RM, Falkenhagen KM, White C,
52 Plastic and Aesthetic Research ¦ Volume 4 ¦ March 22, 2017