Becky Gladis


Dermatology Nursing. 2003;15(1) 


This 65-year-old male presented with a chief complaint of an enlarging and disfiguring nose over a period of several years. He has a long history of acne rosacea, which has been kept under control with the use of oral antibiotics. He denies trauma to the area and also denies any obstructive breathing problems.

Upon examination the nose is noted to have drastic overgrowth of the sebaceous glands and a thickening of the epidermis. His nose has a red/violet appearance (see Figure 1).

Rhinophyma prior to treatment.

Rhinophyma is the "end stage" of sebaceous overgrowth and scarring from poorly controlled acne rosacea. It is predominantly seen in men age 40 and older.

The word rhinophyma comes from the Greek language: rhinis meaning nose and phymameaning growth. Rare cases have also been noted to involve the ears.

This skin condition is frequently referred to as the "W.C. Fields" nose. Rhinophyma consists of hypertrophic nodular growths on the distal half of the nose. The nose becomes very fibrous and inflamed, often becoming deep red or purple in color due to diffuse telangiectasias.

Rhinophyma is best treated with surgical ablation of the tissue. Cases with minimal involvement can easily be treated with electrosurgery (see Figure 2). In moderate to severe cases, carbon dioxide laser surgery provides the best cosmetic improvement. Additionally a vascular laser can be used to restore normal skin color. The goal of treatment is to return the nose to a prediseased appearance and function.

Rhinophyma following electrosurgical treatment.

The severity of rhinophyma is variable from patient to patient. Acne rosacea is still present after surgical correction of rhinophyma; therefore, patients must continue to be treated to minimize the risk of recurrence.

The nurse must provide instruction on an effective skin cleansing routine, the skin conditions of rhinophyma and acne rosacea, and the proper use of the topical and/or oral medications that are prescribed. In the immediate postoperative period, all patients must follow proper wound care instructions provided by the nurse.