Published on 16/03/2015 by admin
Filed under Dermatology
Last modified 16/03/2015
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John Berth-Jones
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Phymas, of which rhinophyma is much the most common, are localized swellings of facial soft tissues due to a variable combination of fibrosis, sebaceous hyperplasia, and lymphedema. They occur on the nose (rhinophyma) and, less often the ears, forehead, or chin. They are seen much more frequently in males than in females. Rhinophyma may develop in patients with a long history of rosacea, when it is often regarded as a complication or ‘end stage’ of the disease. However, rhinophyma is also seen in patients who have no history of rosacea. Occasionally rhinophyma is complicated by the development of a malignancy.
Phymas require physical ablation or removal, usually by surgery. Remodeling is most often achieved simply by paring off the excess tissue with a scalpel. Other techniques that can be useful in the hands of those with the necessary expertise include electrosurgery, excision/vaporization with argon, CO2, Nd : YAG or Er : YAG lasers, and cryotherapy. Ionizing radiation has been used in cases with coexisting malignancy. Systemic isotretinoin can significantly reduce the bulk of rhinophyma, although it does not restore normal skin contours. It is possible, but not established, that treatment of rosacea may inhibit the development of rhinophyma.
Biopsy is occasionally indicated to exclude malignancy
Lutz ME, Otley CC. Dermatol Surg 2001; 27: 201–2.
Rhinophyma can be complicated by the development of a malignancy, which can be difficult to recognize.
Curnier A, Choudhary S. Ann Plast Surg 2002; 49: 211–14.
The authors report pleasing results in six patients treated by tangential excision for debulking, the use of scissors for sculpting, and mild dermabrasion for final contouring.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Surgical paring
Electrosurgery
Argon laser
CO2 laser
