The aim of this investigation was to systematically review the current literature to clarify which treatment options are currently used for severe rhinophyma, a rare disfiguring disease affecting the nose; what is the ideal treatment for severe rhinophyma; and what real advantages could be achieved by using these techniques either alone or in combination.

Method: A comprehensive literature review using the PubMed, Scopus, Medline, Google and Google scholar databases was performed. The key words used for the online research were: ‘rhinophyma treatment’, ‘rhinophyma surgery’, ‘severe rhinophyma’ and ‘rhinophyma management’. After the first step of the selection process, the retrieved articles were fully analysed. 

Results: The initial literature search yielded a total of 1319 articles. However, after titles and abstracts were screened for relevance, only 32 articles met the definitive inclusion criteria. The analysis of these manuscripts demonstrates that although many treatment options have already been described in the literature, there is no general agreement on the ideal treatment of rhinophyma.  

Conclusions: The authors concluded that despite a number of suggested treatment modalities, each with a reasonable success rate, surgical treatment using combined techniques is the only truly successful option for the management of severe rhinophyma.

Rhinophyma was noted by Greek and Arabian physicians as early as 2000 BC1. The Viennese dermatologist Ferdinand von Hebra first described the disease in 18452. The name derives from the Greek rhis, for nose, and phyma, meaning growth. Rhinophyma is considered to be the fourth stage of evolving rosacea as described by Rebora3. The lower half of the nose is usually the only structure involved, even if mentophyma, otophyma, blepharophyma, and zygophyma have been described.

Clinically, the nasal skin is irregularly thickened, with associated erythema and telangiectasia. In severe cases, the skin can have pits, fissures, and scarring with enlarged pores. Tumorous growths can develop in late, nodular forms of the disease, producing dramatic cosmetic deformity and occasional functional problems (nasal airway obstruction with obstructive sleep apnoea). Usually, the bony and cartilaginous frameworks are unaffected4. Caucasian people between 45 and 60 years of age are more frequently affected by this disease with a male–female ratio of 12 : 15–7. The aetiology remains obscure, although a number of causes have been proposed, such as vitamin deficiencies, stress, excessive effect of androgenic hormones, and invasion by the Demodex folliculorum mite8. While the association between rhinophyma and alcoholism has not been demonstrated, many patients are still stigmatised by this myth4,9. The deformity of rhinophyma can complicate accurate examination of the nasal skin. As a result, malignancies can go unnoticed within the hypertrophied skin4. While rhinophyma is generally considered as a benign lesion, an association with skin neoplasms such as basal (BCC) and squamous cell carcinomas (SCC) has been described, and sporadic reports of malignancy developing within rhinophyma have been published in the literature10–15. Although clinical diagnosis of rhinophyma may often appear easy, a number of macroscopic changes, including ulceration, rapid growth, and drainage should alarm the physician and be considered as suspicious of a malignant degeneration and pathological examination may be necessary16.

Historically, a number of treatment options have been extensively described in the literature for rhinophyma. Radiotherapy has largely been abandoned owing to its association with secondary skin malignancies17, 18, while medical treatment with antibiotics or retinoids (i.e. isotretinoin to suppress sebum secretion) is useful only in the very early stages. Therefore, there is general agreement that the mainstay of treatment for rhinophyma remains surgical removal of the hypertrophied tissue.