[Rhinophyma : Successful treatment with low-dose oral isotretinoin]. / Rhinophym : Therapieerfolg mit niedrig dosiertem systemischem Isotretinoin.

Rhinophyma is a form of rosacea and is often cosmetically disfiguring. There are various therapeutic ablation modalities. Surgery is often associated with down-time and side-effects. We describe successful treatment with low-dose isotretinoin as a safe alternative with a lower risk of complications. We also discuss the advantages and disadvantages of various therapeutic modalities.

Swept-Source Optical Coherence Tomography and OCT Angiography of Minocycline-Induced Retinal and Systemic Hyperpigmentation.

This is a report of an 80-year-old man with a history of rosacea and rhinophyma treated for 15 years with oral minocycline who developed significant minocycline-induced hyperpigmentation. He also had a history of Fuchs' endothelial dystrophy and had undergone penetrating keratoplasty in the right eye. Best-corrected visual acuity was 20/60 in both eyes. Examination revealed slate-grey hyperpigmentation of his body, face, and sclera and black, confluent pigmentation in the central maculae of both eyes. Green wavelength fundus autofluorescence demonstrated speckled hyperautofluorescence in the right eye, and swept-source OCT and OCTA demonstrated pigmented epithelial detachments and significant signal blocking without choroidal neovascularization.

Rosacea: pathogenesis and therapy.

Rosacea is a chronic facial inflammatory disease. The pathogenesis, diagnosis and treatment are reviewed.

Coblation of rhinophyma.

INTRODUCTION: Rhinophyma is a disfiguring hypertrophy of the skin of the tip of the nose. OBJECTIVE: To assess the new technique of coblation of rhinophyma. STUDY DESIGN: Case series of six patients. RESULTS: All patients had a good cosmetic result. Comparison with existing techniques showed advantages due to the lower tissue temperature involved. CONCLUSION: Coblation of rhinophyma is an effective treatment with few side effects.

[Rosacea: pathogenesis, clinical forms and therapy]. / A rosacea patogenezise, klinikai formái és kezelése.

Rosacea is one of the most common chronic dermatological diseases. It is characterized by transient or persistent facial erythema, teleangiectasias, papules and pustules, usually on the central portion of the face. Rosacea can be classified into four main subtypes: erythemato-teleangiectatic, papulopustular, phymatous, and ocular. These subtypes require different therapeutic approaches. Regarding to the pathomechanism, several hypotheses have been documented in the literature, including genetic and environmental factors, vascular abnormalities, dermal matrix degeneration, microorganisms such as Demodex folliculorum and Helicobacter pylori, but the cause of rosacea is still not known. Authors in this article review current literature on new classification system of rosacea, as well as the main pathogenetic theories and current therapeutic options.

Rhinophymous leishmaniasis: A new variant.

Cutaneous leishmaniasis is known for its wide clinical spectrum. The nose is one of the usual sites where the disease can present in many forms, such as psoriasiform plaques, furunculoid nodules, lupoid plaques, and erysipeloid or mucocutaneous types. We present a new morphology, i.e. rhinophyma-like plaque in an elderly male patient who presented with a large infiltrated plaque involving his nose and the adjoining area of his upper lip. It appeared to be rhinophyma of the nose but was diagnosed as cutaneous leishmaniasis after the demonstration of leishmania parasites in a skin smear preparation; he was treated satisfactorily with antimonials.

Empleo del Adhesivo tisular Tisuacryl en el tratamiento quirurgico del rinofima / Employment of the Tisuacryl tissular adhesive in the surgical treatment of ¿rinofina?

El tisuacryl es un biomaterial de origen sintético basado en 2-cianocrilato de N-Butilo que tiene la propiedad de endurecerse en presencia de los fluidos biológicos y adherirse fuertemente a los tejidos, presentando propiedades hemostáticas y bactericidas; es un producto biodegradable. El Rinofima es una enfermedad que se observa con más frecuencia en la población masculina mayor de 50 años; su etiología está asociada con la cantidad y calidad de los anexos cutáneos, la infección local crónica entre otras causas. Se caracteriza por el crecimiento y enrojecimiento de toda la nariz pudiendo llegar a formar tumores que la deforman. Se han utilizado diversas modalidades de tratamiento. En este trabajo, presentamos 3 casos con Rinofima donde se le realiza remodelación nasal con bisturí y electrocauterio aplicando el tisuacryl en toda el área nasal operada; se observa buena evolución en el postoperatorio sin dolor ni sangramiento. El tisuacryl funciona como protector quirúrgico de la zona operada y evita la infección. El enfermo puede manejar con facilidad el postoperatorio ya que se eliminan las curas diarias y las visitas a los hospitales en los primeros 7 días del postoperatorio(AU)

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.

A case of sarcoidosis mimicking rhinophyma.

A 54-year-old man presented with symmetric, bulbous, nodular enlargement of his nasal tip and ala. At first inspection, the changes appeared to be consistent with rhinophyma, but biopsy revealed noncaseating granulomata consistent with sarcoidosis. His laboratory, radiographic, and functional studies were consistent with systemic involvement of his disease.

Rosacea: a common, yet commonly overlooked, condition.

Rosacea is a common, but often overlooked, skin condition of uncertain etiology that can lead to significant facial disfigurement, ocular complications, and severe emotional distress. The progression of rosacea is variable; however, typical stages include: (1) facial flushing, (2) erythema and/or edema and ocular symptoms, (3) papules and pustules, and (4) rhinophyma. A history of exacerbation by sun exposure, stress, cold weather, hot beverages, alcohol consumption, or certain foods helps determine the diagnosis; the first line of treatment is avoidance of these triggering or exacerbating factors. Most patients respond well to long-term topical antibiotic treatment. Oral or topical retinoid therapy may also be effective. Laser treatment is an option for progressive telangiectasis or rhinophyma. Family physicians should be able to identify and effectively treat the majority of patients with rosacea. Consultation with subspecialists may be required for the management of rhinophyma, ocular complications, or severe disease. (Am Fam Physician 2002;66:442.)

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.

[Rhinophyma--conservative or surgical treatment?]. / Das Rhinophym--konservativ oder chirurgisch behandeln?

On the basis of a case of their own, the authors report on the evolution of a rhinophyma. Therapeutic results obtained with conservative treatment were not satisfactory. In contrast, a combination of surgical removal of the skin changes and systematic treatment with isotretinoin was associated with good results. Contraindications and possible side effects must always be borne in mind.

[Oral treatment of rosacea with 13-cis-retinoic acid]. / Orale Behandlung der Rosazea mit 13-cis-Retinsäure.

Thirteen patients with severe rosacea (rosacea papulopustolosa, rosacea conglobata, and rhinophyma) were treated orally with 0.05, 0.5, or 1.0 mg/kg body weight 13-cis-retinoic acid (isotretinoin, Ro 4-3780) for 12-28 weeks. All patients had been treated previously with high doses of tetracyclines, metronidazole, or dermabrasion, etc., with no or only limited success. The therapeutic effect following 13-cis-retinoic acid was excellent. Inflammatory lesions regressed by 50% within 2 weeks, and by over 95% within 8 weeks. 13-cis-retinoic acid acts as a potent anti-inflammatory and sebum-suppressive agent. Besides papulopustules, nodules, and hemorrhagic abscesses, the inflammatory plaques and facial edema, but to a lesser extent teleangiectasias and the chronic conjunctivitis disappeared. The severe seborrhea disappeared. Long-lasting remission, similar to patients with severe acne being treated with 13-cis-retinoic acid, can be expected, as the first patients are in full remission for over 12 months at the time of writing. Exfoliative cheilitis occurred in every patient. Serum lipids increased only slightly. For female patients a reliable contraception is mandatory as teratogenicity cannot be excluded in this drug (similar to all retinoids).