Rhinophyma – Types, Pathophysiology and Treatment


Rhinophyma is a benign condition of the nasal skin that results in abnormal growth and enlargement of the nose. While this is not cancerous, it results in a reddened, “bumpy” appearance of the nose that can be highly disfiguring. The etiology of this condition is multifactorial, but it is thought to represent advanced-stage rosacea that occurs in a minority of patients. However, while rosacea is more common in women, rhinophyma predominantly affects men.

The condition results in dilated blood vessels, chronic swelling and inflammation, and an increased number of sebaceous glands in the nose. This makes the nose appear reddened, thickened, and bulbous. There may also be prominent blood vessels and abnormal pitting and scarring of the skin. Alcohol and caffeine can exacerbate this condition.

In addition to being disfiguring, the significant enlargement of the nose may become so severe as to create or worsen nasal obstruction, making it difficult to breathe out of the nose. People with rhinophyma may also have skin cancers that are difficult to detect due to the diffusely abnormal appearance of the skin.

Types of rhinophyma

There are several types of rhinophyma, which include glandular rhinophyma, fibroangiomatous rhinophyma, and actinic rhinophyma.

Glandular Rhinophyma

Glandular rhinophyma refers to an enlargement of the sebaceous glands over the nose. To note, sebaceous glands secrete an oily substance called sebum that maintains suppleness of the skin and prevents its drying.

The surface of this type of rhinophyma is pitted or indented and the swelling is asymmetrical. When the skin surface is compressed between the fingers, there may be secretion or oozing of sebum, along with dead skin cells and bacteria. The nasal skin may acquire a secondary bacterial infection that can lead to complications such as scarring.

Fibroangiomatous rhinophyma

Fibroangiomatous rhinophyma is a condition that causes the nose to turn red or copper in color. The nose appears to be edematous with visible veins on its surface and there may be pustules across the surface.

Actinic rhinophyma

Actinic rhinophyma involves the development of nodules of elastic tissue across the nose.


The prevalence of rosacea is 5.46% with an estimated range between 0.092% and 2.41% per a 2018 meta-analysis. Previous literature estimates the female-to-male ratio to be 3:1; however, Gether et al showed equal affliction of the disease between males and females. In contrast to rosacea, rhinophyma is more common in men. The estimated male-to-female ratio of patients with rhinophyma ranges from 5:1 to 30:1 and is believed to be mediated by increased androgen activity in males. Rhinophyma most commonly affects Caucasians between their fifth and seventh decade and is rare among African American populations and in Asia.


Mechanisms of the pathogenesis of rosacea, and in turn rhinophyma, have not been completely elucidated and are thought to be multifactorial, involving a combination of neurovascular dysregulation and innate immune responses. Initially, vasodilation leads to fluid leakage into the dermal interstitium and matrix, predisposing to inflammation, fibrosis, and characteristic erythematous skin due to telangiectatic growth. Increased mast cell presence has been appreciated in all forms of rosacea and appears in the highest density when papules and pustules begin to develop.


The cause of rhinophyma is not fully understood.

Theories include:

  • Enlarged blood vessels may predispose to skin thickening.
  • Vascular instability may lead to leakage of fluid into the tissues. This subsequently triggers inflammation and scarring.

Rhinophyma predominantly affects men. The male-to-female ratio in patients with rhinophyma ranges from 5:1 to 30:1. This is possibly due to androgens (male hormones).

Symptoms of Rhinophyma

Rhinophyma generally takes place in a later stage of acne rosacea. The patient may experience some of the following symptoms:

  • Very sensitive skin
  • Sudden flushing of face
  • Blotchy, red area in the center of the face
  • Telangiectasia: Small blood vessels over the nose and cheeks get swollen up
  • Conjunctivitis: Redness within the eyelids
  • Ocular rosacea: Grittiness or burning in the eyes
  • Blepharitis: Eyelids get inflamed

With further development in rosacea, the symptoms become even more intense, with the onset of rhinophyma. For instance, the oil glands and connective tissue on the nose may increase. The affected individual may experience the following changes in their nose:

  • Enlarged pores
  • Nose slowly grows into bulbous, swollen shape
  • Thickening of the outer layers of skin
  • Numerous oil glands
  • Rough, waxy, yellowish appearance
  • Reddish skin tone

Risk factors

Risk factors include gender and age. Rhinophyma occurs more often in men than in women. The condition gradually develops after the onset of the initial stages of rosacea, which typically happen between the ages of 25 and 50.

You’re at a higher risk for more severe rosacea and rhinophyma if you have:

  • Fair skin
  • An Irish, English, Scottish, Scandinavian or Eastern European racial background
  • A family history of rosacea

Complications of Rhinophyma

The major complications of rhinophyma surgery includes exposure or destruction of cartilage leading to chondritis.


The diagnosis is usually made based on the site involved and appearance of the skin. If the diagnosis is unclear a dermatologist may take a small skin biopsy under local anaesthetic for examination under the microscope.


Treatment of established rhinophyma can be very challenging and can include a combination of different treatment options. Oral treatments do not usually work very well in established rhinophyma, and surgery is often necessary. The aims of surgical treatments are to remove the excess tissue and restore the natural shape of the nose as much as possible by shaving off the extra layers of skin. It takes about a week to heal from the surgery and about 6 weeks after the procedures, the skin will look smoother. Depending on the severity and extent of the rhinophyma a doctor may offer some of the following treatments:

Management options


  • Oral isotretinoin, a retinoid (see relevant leaflet) commonly used for the treatment of acne, may be effective by reducing redness and the growth of the sebaceous glands.


  • CO2 laser, is the preferred and most common method of treating thickened skin. It shaves down the bumps induced by thickening skin. This procedure causes the least amount of bleeding, however, by using the traditional fully ablative CO2 laser, there is risk of pigmentary changes and scarring.
  • Scalpel or razor blade excision, this involves using either a scalpel or razor blade in a controlled manner to help remove the excess tissue.
  • Dermabrasion, this technique involvesusing a wire brush or a burr (a wheel with rough edges) which rotates rapidly and removes the upper layers of the skin. It causes bleeding and there is a risk of cutting too deep, which can cause scarring and permanent color changes to the skin.
  • Electrosurgery and Electrocautery, this procedure uses devices that deliver high frequency electrical currents that heat up and help remove excess tissue. It may cause bleeding.

The surgical treatments can be performed either by dermatologists, plastic surgeons or ear nose and throat surgeons.  There are advantages and disadvantages with all of the above treatments which your specialist will discuss with you. Sometimes more than one attempt or a combination of different treatments is required to obtain a good outcome.  Surgical treatments for rhinophyma are not routinely commissioned. Please check with your doctor if funding may be available locally and if not how to apply in exceptional circumstances.

It is important to note that these treatments do not cure rhinophyma; they aim to remove overgrowth of excess tissue and reshape the nose. Recurrence of the problem can occur which may then require further treatments.

How to prevent rhinophyma

It is recommended to protect your skin from the sun by using a sunblock with a sun protection factor of at least 30. Lifestyle changes may also be recommended to manage symptoms. This includes avoiding:

  • Smoking tobacco
  • Alcoholic drinks
  • Spicy foods
  • Caffeinated drinks
  • Rubbing the face
  • Too much sunlight
  • Extreme temperatures

Getting rid of these factors can help to reduce the appearance of redness and of blood vessels in some people with rhinophyma.

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