Rhinophyma References – Rosacea Treatment [Clinic]



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Rosacea rhinophyma occurs much more commonly in men than women and may not be accompanied by the other symptoms of rosacea. Skin cancer may be masked by rhinophyma and has been associated with higher levels of mast cells. The management of rosacea rhinophyma involves the usual rosacea treatments and laser treatment for rhinophyma. Association Between Rosacea Rhinophyma and Increased Mast Cells Researchers have pointed out that rhinophyma (enlargement of the nose), usually a later manifestation of rosacea, is also characterized by increased numbers of mast cells. Aroni K, Tsagroni E, Kavantzas N, Patsouris E, Ioannidis E. A study of the pathogenesis of rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process. Archives of Dermatological Research DOI: 10.1007/s00403-007-08162. Basal Cell Carcinoma (Skin Cancer) & Rhinophyma [April 2007] Basal or squamous cell carcinomas have rarely been reported occurring in rhinophyma. Clinical diagnosis can be difficult as the characteristics of carcinomatous lesions may be overlooked given the background of soft tissue hypertrophy and distortion seen in gross rhinophyma. A 77-year-old man with long standing gross rhinophyma developed a 6 x 8-mm ulcerated nodular lesion on the right side of his nose. Such a lesion would normally have been clinically obvious when occurring on normal skin; however. given the soft tissue hypertrophy and general nodularity of the nose due to rhinophyma, it had not been initially apparent. The patient had been attending the Clinic for treatment of his acne rosacea. He had also recently been assessed in the plastic surgery department for shave removal of the larger protuberant parts of the rhinophyma to improve the appearance of his nose. There was a history of severe ischaemic heart disease; surgery had therefore been cancelled because of concerns about unduly high anaesthetic and surgical risks for this cosmetic procedure. The ulcerated nodule was only considered subsequently on close inspection to be suspicious of neoplasm. Diagnostic punch biopsy confirmed the presence of a nodular microcystic basal cell carcinoma (BCC). The patient had no previous history of skin cancers and no other clinically suspicious lesions. Despite developing quite a large BCC in a prominent location, the gross appearance of the nose had caused it to be overlooked. Even the patient himself had not been concerned. In 1967 Acker and Helwig reviewed 47 cases of rhinophyma and found that five had developed a BCC on the nose. Using epidemiological data, they concluded that BCC occurred on the nose in a significantly greater proportion of patients with rhinophyma than in those without. However, Keefe et al. later showed that the statistical technique used had been incorrect, and biases in the study prevented generalization. Using the correct technique, the results of Acker and Helwig just failed to reach statistical significance at the 5% level. There have been sporadic published reports in the literature of carcinoma developing within rhinophyma. In 1990, Silvis and Zachary summarized the previously reported cases. They added a case of basal cell carcinoma to the previous 10 cases of BCC of squamous cell carcinoma and 2 of unspecified carcinoma. Since then there have been very few published reports of carcinoma developing within rhinophyma. Recently, a retrospective epidemiological audit of 45 cases of rhinophyma treated surgically found no coincidental malignancies on histology. In theory, a causal association between rhinophyma and BCC might be explained by the chronic inflammation, hypertrophy, hyperplasia and scarring that occurs in rhinophyma. Our case has prompted us to look for evidence of a causal association, but opinion in the literature has been divided. There does not appear to be definite proof that the two conditions do not occur together by chance. Further larger studies would be required to clarify this question. However. the importance of careful examination of the skin in rhinophyma for coincidental carcinoma, and diagnostic biopsy of suspicious areas is emphasized by our case. The distortion and soft tissue hypertrophy of gross rhinophyma may make carcinomatous lesions more difficult to recognize clinically and early lesions may go unnoticed. The surgical margins could also be more difficult to define. Mohs' micrographic surgery could be considered, and is felt by some to be the treatment of choice for carcinoma arising within rhinophyma. Alternatively, radiotherapy is an accepted treatment option for rhinophyma and for BCC, and has successfully been used to treat both conditions when they occur together. Skin Cancer Prevention: Antioxidants; Rosacea Sunscreens. Related Rosacea Treatment Information and Notes: Basal Cell Carcinoma (Skin Cancer) & Rhinophyma [April 2007] Rosacea: A Potential Complication of Skin Cancer Removal [April 2007] (Non)Comedogenicity of Skin Care Ingredients in Rosacea Skin Care Products Invisible Daylight Exposure Produces Dry Skin in Rosacea Preservatives in Skin Care and Skin Irritation Order of Application Including Metrogel (Metronidazole) Additional Resources: About Basal Cell Carcinomas – DERM NET NZ. Skin Cancer Information, including treatment and prevention – frequently updated, at the general dermatological skin care site from Melbourne Dermatology. Commonly Held Misconceptions about Sun Exposure. Australian Skin Cancer Campaign (Quicktime Video and links to more information on treatment and prevention) [AU] [UK] References Acker OW. Helwig EB. Rhinophyma with carcinoma. Arch. Dermatol. 1967; 95: 250-4. Keefe M. Wakeel RA. McBride Dr. Basal cell carcinoma mimicking rhinophyma. Case report and literature review. Arch. Dermatol. 1988; 124: 1077-9. Silvis NG. Zachary CB. Occult basal cell carcinoma within rhinophyma. Clin. Exp. Dermatol. 1990; 15: 282-4. Curnier A. Choudhary S. Rhinophyma: dispelling the myths. Plast. Reconst. Surg. 2004; 114: 351--4. Tamir G. Murakami C. Berg O. Moh's surgery as an approach to treatment of multiple skin cancer in rhinophyma. J. Cutan. Med. Surg. 1999; 3: 169-71. Plenk HP. Rhinophyma associated with carcinoma, treated successfully with radiation. Plast. Reconst. Surg. 1995; 95. Rhinophyma Laser Treatment for Rhinophyma Rosacea Anti-Inflammatory Clearing Serum – Evening Use More than three years in research and development, Rosacea Anti-Inflammatory Clearing Serum is a breakthrough product featuring remarkable ingredients and unprecedented formulation expertise aimed at dramatically improving the health and appearance of rosacea patients' skins in a minimum of time. Rosacea Anti-Inflammatory Clearing Serum provides a plethora of interrelated benefits: relieves and inhibits skin inflammation, redness and discomfort – markedly more effective than Rosacea Treatment Fluid and Cream; speeds clearance of pimples, papules and pustules and helps prevent their recurrence – more effective than RosaTox Soothing Mask Powder and Enhanced Azelaic Acid Gel-Cream; refines skin texture without irritation (contains no alpha hydroxy acids); reduces the appearance of fine lines and enlaged pores characteristic of rhinophyma; rejuvenates skin while durably improving moisturization and hydration; brightens skin tone and reduces hyperpigmentation (areas of uneven pigmentation, such as age spots and laser-induced discolouration); prevents skin tissues from becoming rigid and less pervious to the absorption of effective treatments, including the rosacea medications metronidzole and azelaic acid; promotes collagen synthesis to improve skin's firmness and elasticity. Ingredient/Formula Notes Ingredients clear, hydrate, re-surface, de-sensitize, brighten and lightly firm skin while providing anti-aging benefits. Notable ingredients used in beneficial concentrations are a range of non-aromatic plant-derived, anti-inflammatory moisturizing oils which form a base for extracts of grape seed, mulberry, willow, licorice, echinacea and marigold in addition to Co-Enzyme Q10, amino acids, ergothioneine, resveratrol, antioxidants and vitamins. Produced in small batches to preserve beneficial activity – use within 4 months of opening. Store in a cool, dark place. May be refrigerated to enhance it's anti-inflammatory effects. Contains no ingredients redundant to product performance. Free of preservatives, colourings and fragrance. Product Texture Ultra-light, sheer oil, readily absorbed. Rosacea Anti-Inflammatory Product Suitability All skin types suffering from rosacea, from the oiliest to the driest of skin. Especially suitable for very dry skin, very oily congested skin and irritated skin of any type, particularly if characterised by an uneven texture, papules or pustuls. Dermatologist-tested, allergy-tested and non-comedogenic. Clinical tests on over 300 rosacea patients over 2 years confirm efficacy. Instructions for Use Evening only. Cleanse skin thoroughly with either Oil-Free Purifying Gel Cleanser or De-Sensitizing Cleansing Emulsion and gently pat skin dry. Spray skin lightly with Hydrating De-Sensitizing Mist or Purifying De-Sensitizing Mist and leave skin to rest for approximately 5 minutes. Apply Rosacea Anti-Inflammatory Clearing Serum to the entire face (and optionally neck), concentrating on those areas prone to redness, uneven skin texture, pimples, papules or pustules. Leave for at least 2 hours, or overnight. Additional moisturizer will not be required and should not be applied over the serum to avoid reducing the effectiveness of the product. If any traces of the product remain before retiring, gently massage into the skin. There is no maximum use for this product. To sustain effectiveness, at minimum prepare skin gently (see Rosacea Cleansers and De-Sensitizing Mists) and always use adequate photoprotection (see Rosacea Sunscreens and photoaging) the next morning. Rosacea Anti-Inflammatory Clearing Serum Ingredients Prunus Amygdalus Dulcis Oil, Prunus Armeniaca Kernel Oil, Vitis Vinifera Extract, Macadamia Ternifolia Seed Oil, Morus Nigra Root Extract, Morus Bombycis Root Extract, Scutellaria Baicalensis Root Extract, Glycyrrhiza Glabra Extract, Corylus Avallena Seed Oil, Rosa Rubiginosa Seed Oil, Oenothera Biennis Oil, Rubus Idaeus Seed Oil, Ubiquinone, Carnitine, Ergothioneine, Simmondsia Chinensis Oil, Cyclomethicone, Butyrospermum Parkii Oil Unsaponifiables, Salix Alba Extract, Tocopherol Acetate, Aloe Barbadensis Leaf Extract, Glycine Soja Oil Unsaponifiables, Atellocollagen, Sodium Condroitin Sulfate, Echinacea Angustifolia Leaf Extract, Glycerin, Lactobascillus Ferment, Retinyl Palmitate, Proline, Lysine, Persea Gratissima Oil Unsaponifiables, Calendula Officinalis Flower Extract, Ascophyllum Nodosum Extract, Resveratrol, Panthenol, Allantoin, Alpha Tocopherol. About Rosacea Treatment Treatment varies according to the type of rosacea, however all treatments must focus on identifying and avoiding triggers which produce redness: The most frequent triggers include daylight exposure (see protection – rosacea sunscreens) and the use of inappropriate skin care. Other triggers include alcohol consumption, hot drinks and spicy foods. Less common triggers include food sensitivities such as those to tomatoes and cheeses. Daily use of sunscreen (see what is the best sunscreen for rosacea?) is important in reducing the frequency of symptoms and also has anti-aging benefits. Anti-inflammatory and reparative skin care products containing high concentrations of antioxidants and free of all known allergens and irritants, such as paraben preservatives and sodium laureth sulphate, are important factors in optimal care. For the mildest cases of rosacea, characterised by persistent redness and skin irritation only, treatment focuses on The Clinic's speciality rosacea skin care products. More resistant cases (see treatment revision) may require additional in-office topical, laser or light treatments. Medication is rarely prescribed in these instances. Effective treatment of mild rosacea reduces the likelihood of disease progression. Rosacea characterised by pimples, papules and pustules, in addition to persistent redness, requires the treatment outlined above in addition to periodic or ongoing treatment with topical and/or oral medications. Ocular rosacea – produces blood-shot, gritty and itchy eyes, and foreign body sensations – is managed by our specialist ophthalmologist. Rhinophyma (distortion of the shape of the nose) is treated with surgical lasers in combination with oral medication to help maintain improvement. Rosacea Rhinophyma Rosacea rhinophyma, a subtype of rosacea referred to as phymatous rosacea ("phyma" is the Greek word for swelling, mass and bulb), refers to the following nasal symptoms: increase in size bulbous growths and/or (clumps of) nodules ruddy texture and colouring irregular fibrous tissue growth hypertrophy (overgrowth) of the sebaceous (oil) glands The symptoms of rosacea rhinophyma can also occur elsewhere including on the cheeks, ears, forehead and chin. Rosacea rhinophyma occurs much more commonly in men than women and may not be accompanied by the other symptoms of rosacea. Skin cancer may be masked by rhinophyma and has been associated with higher levels of mast cells. The management of rosacea rhinophyma involves the usual rosacea treatments and laser treatment for rhinophyma.			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