LAUSR

Rhinophyma is considered the final stage of evolving acne rosacea and is characterized by skin thickening and painless hyperplasia of the sebaceous glands and connective tissue, leading to progressive nose skin deformity which causes an enlargement of the lower two-thirds of the nose. It can also affect the chin (gnatophyma) as well as the forehead (metophyma), eyelids (blepharophyma), or ears (otophyma). Although acne rosacea is a common disease with a prevalence ranging from 0.5 to 10%, affecting women mainly, rhinophyma mostly occurs in men with a ratio of male to female patients ranging from 12:1 to 30:1, maybe due to their androgenic influence. Rhinophyma is mostly seen in men over 40 years of age. Currently, etiology is still unclear, and it is likely to be a multifactorial mechanism leading to unregulated superficial vasodilatation and, consequently, chronic edema, inflammation, fibrosis, and hyperplasia. Moreover, alcohol and caffeine consumption, sun damage, and sun exposure are considered to be exacerbating factors due to their vasodilatation properties. Pathological mechanisms of rosacea are due to an exacerbated response by innate immunity to environmental stimuli such as UV, microorganisms, and physical and chemical trauma. It seems that the main role in pathogenesis is played by abnormal vascular reactivity. The diagnosis is clinical, but histopathology is useful not only in confirmation but also to exclude malignancies as basal cell carcinoma (occurring from 3 to 10% of rhinophyma cases) and other types of skin cancers as granuloma eosinophilicum, angiosarcoma, sarcoidosis, sebaceous carcinoma, adenoid and squamous cell carcinoma, lymphoma, and sebaceous adenoma. A spontaneous regression of rhinophyma is rare. Late stages of rhinophyma present only in low-income countries today, where patients have no possibility to treat the disease early. For these patients, two types of treatment are available: medical and surgical therapy. Oral isotretinoin seems to be an effective and well-tolerated treatment by reducing facial cutaneous blood flow and sebaceous gland growth. Daily doses of isotretinoin range from 0.2 mg/kg to 1 mg/kg, generally for 6 months. Surgery is reserved for advanced stages of rhinophyma and is considered the optimal treatment. The surgery aim is to remove the hypertrophied sebaceous glands, with subsequent normalization of nasal contour. Two different surgical approaches have been described in literature. The first one