Rinofima. Desfiguración estética de la anatomía nasal / RHINOPHYMA. AESTHETIC DISFIGURATION OF THE NASAL ANATOMY

Se describen distintos aspectos del rinofima: historia, etiopatogenia, histopatología, epidemiologia, clínica, diagnósticos diferenciales, tratamientos y pronóstico. Se hace hincapié en que es una enfermedad localizada en la nariz asociada a desórdenes generales, y que repercute en las áreas psicológica y social. Se presenta un caso clínico operado con cirugía plástica. Los autores plantean una hipótesis sobre la etiopatogenia y la fisiopatología de la enfermedad; y consideran a los tratamientos de rinofima como paliativos y no curativos

Different aspects of rhinophyma were described: history, etiopathogeny, histopathology, epidemiology, clinical, differential diagnoses, treatments and prognosis. It is emphasized that it is a localized disease in the nose associated to general disorders, and that it brings psychological and social problems. We present a case operated with plastic surgery. The authors present a hypothesis about the etiopathogeny and pathophysiology of the disease and consider rhinophyma treatments as palliative and non-curative.

Validity and Reliability of a Rosacea Self-Assessment Tool.

The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies.

Rhinophyma: "Less is More" and "Old is Gold".

Rhinophyma is a deforming disorder of the nose and considered the most severe stage of rosacea. Since 1950, a large variety of surgical and non-surgical treatments have been adopted to treat it. From January 2014 to June 2016, we treated ten patients (average age: 58 years) affected by moderate (4) and severe (6) degrees of rhinophyma. A nasal skin decortication was performed with a loop-shaped electrotome (Valleylab E1560 15 x 12 mm) in order to excise the hypertrophic tissue and restore a pleasing appearance to the nose. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266 .

Laser surgery in rhinophyma.

BACKGROUND: Rhinophyma is a benign, disfiguring disorder, commonly referred to as the end-stage of severe rosacea and characterized by a progressive thickening and hypertrophy of the nasal skin and soft tissues. The aim of this paper was to evaluate the efficacy of CO2 laser compared to other laser techniques and surgical methods in the treatment of rhinophyma. METHODS: Twenty-four rhinophyma patients were treated with CO2 laser in our institution from 2003 to 2013. A 10,600-nm CO2 pulsed laser was used in all patients, with a 6-month, post-treatment follow-up. RESULTS: Six months after the last laser session, all patients showed global improvement of their clinical conditions: 19 (79.1%) high improvement (>75%), 4 (16.7%) moderate improvement (50-75%), and 1 (4.2%) low improvement (<25%). CONCLUSIONS: Our study demonstrates that carbon dioxide laser warrants a careful nasal surface ablation, allowing the remodeling of the hypertrophic areas, with an excellent cosmetic result, a very short healing time, and virtually no side effects.

Rhinophyma-like hypertrophy of the nose caused by chronic facial pyoderma in a patient with Crohn's disease.

We present our experience with a 22-year-old man who had Crohn's disease with rhinophyma-like hypertrophy of the nose arising from pyogenic skin disease of the face. The clinical appearance did not precisely match any previously reported skin diseases.

Rinofima: una revisión de la literatura / Rhinophyma: a literature review

El rinofima, a pesar de no ser una entidad común, sí es una patología que altera en forma importante la estética facial del individuo; por tal razón, su entendimiento, adecuado diagnóstico y terapia precisa son de gran relevancia para lograr la mejor recuperación posible. Entre las opciones de manejo existen múltiples herramientas, que van desde la prevención hasta procedimientos quirúrgicos agresivos. A pesar de lo anterior, los pacientes con rosácea, condición patológica inicial, avanzan por los diferentes estadios de la evolución de la enfermedad sin tratamiento médico adecuado, y terminan en el rinofima, condición final del proceso patológico. El objetivo de este artículo fue realizar una revisión de la literatura actual del tema.

The Rhinophyma isn´t a common disease, however it´s a condition that significantly disturbs the facial aesthetics of people; for that reason, its understanding, appropriate diagnosis and precise management are so relevant to achieve the best possible recovery. Between the management options are numerous tools, since prevention to aggressive surgical procedures. Despite this, patients with rosacea, initial pathological condition, move through different stages of disease´s evolution without adequate medical treatment, causing rhinophyma, final condition of rosacea process. The aim of this paper was to review the current literature about this subject.

Clinical presentations and classification of rosacea.

Rosacea is a chronic skin disease affecting up to 10% of the population in some European countries. Rosacea manifests as various combinations of characteristic signs and symptoms in a centrofacial distribution. At present, there is no consensus about the definition or classification of the clinical patterns of rosacea. Initially, four stages were differentiated (pre-rosacea then stages I through III), with several variants (e.g., persistent erythema and edema, rosacea conglobata, and rosacea fulminans). The National Rosacea Society (NRS) in the USA has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (lupoid or granulomatous rosacea). This classification scheme does not mention progression from one type to another and makes no reference to pathophysiological considerations. It uses major and minor diagnostic criteria based on the physical findings and symptoms. The NRS has also developed criteria for grading disease severity. The classification of rosacea into stages or subtypes, without considering the possibility of progression from one to another, will probably remain controversial until additional knowledge on the pathophysiology of rosacea is obtained.

[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.

[Rosacea 2009 : new advances in pathophysiology, clinical staging and therapeutic strategies]. / Rosazea 2009 : Neue Erkenntnisse zur Pathophysiologie, klinische Manifestationsformen und Therapiestrategien.

Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple 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.

Rhinophyma: dispelling the myths.

Rhinophyma is a relatively common condition in the west of Scotland. The Canniesburn Plastic Surgery Unit receives 12 to 13 new patients per year for surgical treatment. The reported incidence of simultaneous carcinoma in the setting of rhinophyma is on the order of 15 to 30 percent. There are conflicting reports about the association between alcohol and rhinophyma in the literature, and these are supported with little or no statistical evidence. Retrospective epidemiologic data on 45 cases of rhinophyma are presented. An audit of case notes was performed to examine histology and also alcohol consumption in these cases. The authors found no coincidental malignancies at the time of surgery, which is contrary to many previous publications. The alcohol consumption of the rhinophyma cases was compared with that of a control group that consisted of 48 men presenting for blepharoplasty. The series did not demonstrate a positive association between alcohol and rhinophyma when compared with a similar cohort of patients presenting for blepharoplasty surgery (p > 0.20) or with statistics available from the Scottish Health Survey.

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.)

Further evidence for the role of fibrosis in the pathobiology of rhinophyma.

Recent evidence suggests that fibrosis may play an important role in the pathobiology of rhinophyma. The fibrogenic cytokine transforming growth factor (TGF)-beta2 has been reported to be up-regulated in rhinophyma tissue. Of the three common isoforms of TGF-beta, TGF-beta1 and TGF-beta2 are considered fibrogenic, whereas TGF-beta3 has antiscarring properties. To provide further evidence for the role of fibrosis in the pathobiology of rhinophyma, specimens from 8 patients with rhinophyma were compared with nine specimens of normal nasal skin. Immunohistochemistry was used to compare intensity levels of TGFbeta1 and TGFbeta3 proteins, and quantitative reverse transcription-polymerase chain reaction was used to determine messenger ribonucleic acid (mRNA) expression levels of TGFbeta1 and TGFbeta3. TGF-beta1 was elevated significantly in rhinophyma tissue (p < 0.001), whereas TGF-beta3 was no different in the rhinophyma specimens compared with normal nasal skin (p = 0.06). TGFbeta1 mRNA expression was five-fold higher in rhinophyma tissue compared with normal skin (p < 0.001). The mRNA expression of TGF-beta3 was the same for both pathological and normal tissue (p < 0.09). These data, together with previously published observations, present further evidence that fibrosis mediated by the fibrogenic cytokines TGFbeta1 and TGFbeta2 play a role in the pathobiology of rhinophyma and suggest a means of treatment by neutralizing or down-regulating these cytokines.

[Rosacea in the year 2001]. / Rosacea anno 2001.

Rosacea is a chronic skin disorder of the face. Initially erythema and telangiectasia develop, followed at a later stage by papules and papulopustules. Females between 30 and 50 years of age are most affected. Pathogenesis is not clearly understood. Finally rhinophyma and persistent lymphoedema can develop. It can be difficult to distinguish acne vulgaris, seborrheic eczema, perioral dermatitis and lupus erythematosus from rosacea. Treatment of first choice consists of topically or systemically applied antibiotics. More severe cases can be treated with isotretinoin. Erythema and telangiectasia respond well to treatment with vascular lasers.