Visible on the nose, rhinophyma is one of the most severe forms of rosacea. Depending on the stage of the disease, different treatments can be adopted. Let's look at the various therapeutic options for rhinophyma that exist today.
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- Rhinophyma: What are the treatments for rosacea on the nose?
Rhinophyma: What are the treatments for rosacea on the nose?
- A closer look at the medicinal treatments for rhinophyma
- Rhinophyma: What are the treatments through mechanical destruction?
- The action of radiofrequency against rhinophyma
- Laser treatments to combat rhinophyma?
- Sources
A closer look at the medicinal treatments for rhinophyma.
An advanced stage of rosacea, the rhinophyma is a pathology characterized by the enlargement and deformation of the nose, following the hypertrophy of the sebaceous glands and connective tissue of the distal region of the nose. Highly visible, rhinophyma can lead to significant social stigmatization. Moreover, this deformation increases the risks of nasal obstruction: the importance of treating rhinophyma as quickly as possible is therefore twofold. When it is at an early stage, it is possible to resort to medicinal treatments.
Oral therapies for managing rhinophyma.
Oral antibiotics, such as tetracyclines, may be prescribed to reduce certain symptoms of inflammation associated with rhinophyma. They can also be used to treat skin bacterial infections that may occur in early stages of rhinophyma. The isotretinoin, traditionally used in cases of severe or recurrent acne, can also help to reduce the size and activity of the sebaceous glands. In cases of mild rhinophyma, it is usually prescribed at low doses, less than 0.5 mg/kg, to halt its progression.
Tamoxifen, a selective modulator of estrogen receptors typically used in cancer cases, could also be relevant in cases of rhinophyma. This drug reduces both the production of TGFß2 by fibroblasts and their contraction, which could help to reduce fibrosis characteristic of rhinophyma. However, in vivo studies are necessary to confirm its clinical applicability, effectiveness, and safety.
Is it possible to use topical treatments in the case of rhinophyma?
Creams and gels containing active substances such as metronidazole, an anti-parasitic, or azelaic acid, an anti-inflammatory, can also be beneficial in cases of early rhinophyma, to prevent its progression and worsening. They can also be prescribed to combat other forms of rosacea, such as telangiectasia and papulopustular rosacea. However, metronidazole and azelaic acid are not sufficient to treat rhinophyma that has reached an advanced stage.
Oral therapies and topical treatments can be prescribed in combination to achieve better results.
Rhinophyma: What are the treatments through mechanical destruction?
Severe forms of rhinophyma are typically treated through mechanical destruction. This often involvesinvasive procedures utilizing various surgical techniques.
An effect of cryosurgery on rhinophyma?
Cryosurgery is a localized treatment that destroys excessive tissues present in the nose through the application of intense cold. Guided by an ultrasound, the doctor inserts cryogenic probes into the area to be treated through the skin to freeze the skin tissues between -40° and -60 °C. This causes the instant cooling of the tissues, leading to the formation of micro ice crystals within the cells and their destruction. In the case of rhinophyma, the most commonly used gas is liquid nitrogen. Cryosurgery allows for a precise destruction of tissues while preserving the nasal cartilage.
Is dermabrasion beneficial in combating rhinophyma?
Commonly used to treat rhinophyma, dermabrasion is a procedure during which the upper layers of the skin are removed using a rotating device equipped with abrasive burrs after the rhinophymatous tissue has been reduced with a scalpel. It helps to smooth the surface of the nose and reduce the appearance of nodules and irregularities. Dermabrasion presents less significant scarring risks compared to surgery.
Is surgical removal possible in the case of rhinophyma?
It is also possible to perform a surgical removal to eliminate rhinophyma. This method involves removing the excess skin tissue on the nose using a scalpel or a surgical knife. It involves surgically cutting the hypertrophied tissues of the nose to reshape them and make them more aesthetically pleasing. The surgical knife blade is often heated between 302°F and 392°F and used to remove significant rhinophymatous tissues. The heat of the blade cuts the tissues and coagulates the blood vessels. This technique carries relatively few risks of recurrence. Surgical removal is often used in cases of severe rhinophyma, presenting a significant amount of hypertrophied rhinophymatous tissues.
Can rhinophyma be treated with electrosurgery?
Finally, rhinophyma can be managed through electrosurgery. This technique uses a high-frequency alternating electric current to cut and remove the hypertrophied tissues of the nose. It can be performed using an electrocautery device or an electric scalpel. However, it is important to note that electrosurgery carries significant risks of burns, hence the need to have it performed by a competent healthcare professional whom you trust. Additionally, achieving hemostasis, that is, the return to normal blood circulation, can be challenging after the operation.
The action of radiofrequency against rhinophyma.
Radiofrequency is a treatment method that uses electromagnetic waves to generate controlled heat within the skin tissues. This heat triggers the coagulation of blood tissues and the contraction of collagen fibers, which can reduce the size of nodules and growths associated with rhinophyma. Radiofrequency also helps to decrease the size of excessive nose tissues and improve its appearance.
Radiofrequency treatment can utilize various techniques based on a similar mode of operation. Among them, fractional radiofrequency, thermocoagulation by radiofrequency, and micro-needle radiofrequency are generally favored in cases of rhinophyma.
Laser treatments to combat rhinophyma?
Finally, laser treatment is an effective option for managing rhinophyma and enhancing the appearance of the nose.
The CO2 ablative laser for treating rhinophyma.
The CO2 ablative laser is a fairly common technique for treating rhinophyma. The CO2 ablative laser generates very short and intense pulses of light. This type of laser emits electromagnetic waves within a mixture of several gases: CO2, nitrogen, and helium. In this way, the CO2 molecules are excited and brought to a higher energy level. This energy is then absorbed by the water present in the skin tissues, leading to a controlled evaporation of the upper layers of the skin. This precise ablation allows for smoothing of skin surface irregularities and reduction in the size of growths associated with rhinophyma.
How does the Pulsed Dye Laser (PDL) work on rhinophyma?
The PDL laser emits light pulses at a specific, adjustable wavelength of 585 to 595 nanometers selectively absorbed by the hemoglobin present in blood vessels. The PDL laser can be used to target dilated or abnormal blood vessels in the nose, in order to reduce their diameter. This helps to alleviate the redness and inflammation associated with rhinophyma.
What is the significance of the Nd:YAG laser in the case of rhinophyma?
The Nd:YAG laser emits light at a specific wavelength of 1064 nanometers, which is absorbed by the melanin pigments in the skin. It can be used to target pigmented or hyperpigmented lesions on the nose, thereby helping to even out skin color and improve its appearance.
Using the KTP (potassium titanyl phosphate) laser to get rid of rhinophyma?
The KTP laser is a so-called vascular laser, meaning it targets blood vessels to shrink their diameter. It belongs to a subclass of YAG lasers and uses the same mechanism of action. The KTP laser emits at a wavelength of 532 nanometers.
Is the Er:YAG Laser Effective Against Rhinophyma?
The Er-YAG laser, also a subclass of YAG laser, emits waves that penetrate deeply into tissues. It has a photoablative effect, meaning it induces pure tissue ablation without thermal injury. This laser emits light at a wavelength of 2940 nanometers.
Despite the effectiveness of all the treatments presented, a recurrence of rhinophyma remains possible.
Sources
PAYNE & al. Further evidence for the role of fibrosis in the pathobiology of rhinophyma. Annals of Plastic Surgery (2002).
PELLE M. & al. Rhinophyma treated with cryosurgery. Dermatologic Surgery (2009).
BERLINGIN E. & al. L’utilisation des lasers en dermatologie. Revue Médicale de Bruxelles (2013).
ZACHARY C. & al. Fractionated ablative carbon dioxide laser for the treatment of rhinophyma. Lasers in Surgery and Medicine (2014).
GRANDE D. & al. Rhinophyma : A treatment review. Dermatologic Surgery (2018).
HASSANEIN A. & al. Rhinophyma: Prevalence, severity, impact and management. Clinical, Cosmetic and Investigational Dermatology (2020).
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