New Rhinophyma Severity Index and Mid-Term Results following Shave Excision of Rhinophyma

Abstract

Background: Rhinophyma is a progressive nasal deformity resulting from hyperplasia of the sebaceous glands and connective tissue, with a negative effect on quality of life. Partial-thickness shave excision has been used for the treatment of rhinophyma, but the mid- and long-term efficacy of the treatment is unknown. Objectives: We analysed the clinical outcomes of shave excision in patients with rhinophyma in our centre between 2005 and 2009. Methods: The entire nose was shaved using a scalpel while under tumescent anaesthesia. The clinical assessment was scored using a novel Rhinophyma Severity Index. Results: Thirty-three patients with rhinophyma and shave excision were recruited for the study. A mid-term follow-up examination was possible in 23/33 (69.7%) patients. After a mean follow-up of 37.4 ± 13.2 months, 21 (91.3%) patients showed an improved Rhinophyma Severity Index (3.3 ± 1.1 to 1.7 ± 0.9, p < 0.0001). All patients reported a high level of satisfaction after surgery (excellent or good result). Eleven (47.8%) patients developed rhinophyma recurrence. Conclusion: Shave excision under tumescent anaesthesia is an effective treatment for rhinophyma. The treatment is associated with high patient satisfaction and minimal side effects. A possible recurrence of rhinophyma must be addressed, however, while obtaining informed consent.

Histopathology of rhinophyma – a clinical‐histopathologic correlation

“…In summary, we found a similar histopathologic pattern in all of our patients regardless of the clinical severity of the disease stratified according to the new clinical rhinophyma score presented by Wetzig et al The formerly reported differentiation between a ‘common’ rhinophyma form that resembles histopathologic features of rosacea and a severe, ‘fibrotic’ form with a reduction or absence of folliculosebaceous structures could not be confirmed in our cohort. There was no histopathologic marker predicting the clinical course or possible recurrence of the disease after superficial decortation by shave excision.…”

“…Prior to excision, the patients gave their written informed consent. According to the recently published new Rhinophyma Severity Index(RHISI, see Fig. A–E), five groups of patients were included [5 patients with moderate skin thickening (RHISI 2), 11 patients with strong skin thickening and small lobules (RHISI 3), 5 patients with lobules and fissures (RHISI 4), 2 patients with giant rhinophyma (RHISI 5) and 1 patient with RHISI 6] as a result of additional clinical findings.…”

“…Rhinophyma Severity Index – RHISI according to Wetzig et al 0: No evidence of rhinophyma (image not shown). A) RHISI 1.…”

Clinical features of Korean patients with rhinophyma

“…2 It has been reported that the initial stages of rhinophyma may respond to antibiotic or oral isotretinoin treatments. 10 In general, surgical procedures are preferred for treating rhinophyma because its progression causes irreversible morphological changes.…”

“…1 This rare disease is mostly noted in middle-aged Caucasian men, 2 and few reports have focused on Asian patients. It is commonly seen in association with chronic rosacea and historically has been considered as the end stage of rosacea.…”