Rosacea is a  chronic disease that affects the skin and sometimes the eyes. Characteristics of the condition include redness, pimples, and, in advanced stages, thickened skin. Although rosacea usually affects the face, it can affect parts of the upper body. Despite how common the condition is, many people with rosacea go undiagnosed.

Approximately 14 million people in the United States have rosacea, and it is more common in women (particularly during menopause) than in men. Rosacea tends to occur more frequently in people with fair skin; however, it can occur in people of any skin color.

Common Symptoms

  • Frequent redness or flushing of the face. The face may also have a burning sensation and slight swelling.
  • Small red lines under the skin, which appear when the blood vessels under the skin get larger. This area of the skin may be somewhat swollen, warm, and red.
  • Constant redness, along with bumps on the skin. Sometimes the bumps have pus inside (pimples), but not always. Solid bumps on the skin may later become painful.
  • Inflamed eyes and eyelids.
  • A swollen nose. In some people (mostly men), the nose becomes red, larger, and bumpy.
  • Thicker skin.

See pictures of Rosacea

Although there is no rosacea cure, the condition can be treated and controlled. Without proper care, rosacea may progress to a more disfiguring condition, known as Rhinophyma.

What Is Rhinophyma?

The most common characteristic or symptom of rhinophyma is an enlarged, bulbous, and red nose. Rhinophyma is associated with the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. The condition is more common in men than women. See pictures of Rhinophyma

Treating Rosacea and Rhinophyma

There is a common four-stage algorithm of treatment for these conditions. The first three stages of rosacea, and the fourth stage is rhinophyma. For the first stage of the pre-rosacea, the mainl treatment is focused on prevention. On the second stage, some topical and oral treatments are used. More agressive medication is typically used during the third stage. If nothing works and rosacea develops into rhinophyma, the only treatment is surgery. Topical treatment includes metronidazole gel and Retin-A; however, Retin-A may exacerbate the erythema. Oral treatments include tetracycline, metronidazole, and Accutane. Radiation and chemical scarification are no longer accepted methods. Originally all surgeries were skin grafted (decortication), as it was feared that the rhinophymatous tissue would recur. Now, however, surgical decortication with preservation of the sebaceous glands fundi is the preferred method of excision. Preservation of the glands will allow spontaneous re-epithelialization. These are the frequently used devices that we may see in rhinophymatous surgery. The oldest method of the rhinophymatous surgery is the excision (the cold technique). The risk of scarring and hypopigmentation are common. Electrosurgery for rhinophyma was introduced in 1950s. There is greater heat dispersion compared to CO2 laser and Cold Knife, which can lead to scarring and hypopigmentation. One can use a wire loop or a hockey stick attachment. Greenbaum, in an interesting study, took three patients and treated one-half of the nose with CO2 laser and then treated the other half of the nose with electrosurgery and concluded that both gave equivalent cosmetic results with equal time to re-epithelialization. However, he stated that the laser technique took him twice as long compared to the electrosurgery technique and he also reported that CO2 laser is 15 to 20 times more costly than the electrosurgery. Stucker states that you should reserve this technique only for diseases on the nasal tip. You can see why, since sometimes you may get some alar notching here. The CO2 laser was introduced in 1980s. Excision of the bulk of rhinophyma was used with the CO2 laser, and vaporization was used for the rest with the depth of 0.1mm. The Erbium:YAG laser use for rhinophyma became available and common in mid-1990s. Better  cosmetic results with shorter healing time were obvious due to the smaller thermal damage zone compared to the CO2. Dermabrasion is another technique used in rhinophyma; however, it is usually used as an adjuvant to other methods. Dermabraders are simple tools that are very effective but may cause a very sever trauma and extended hypopigmentation. The recent advances in laser technologies offer less invasive and very efficacious approach to treating rosacea and preventing rhinophyma. Nd:YAG lasers are used to reduce and control rosacea and to get patients off Accutane, which has been linked to birth defects and other complications. If rosacea has developed into rhinophyma, the Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period. Combined carbon dioxide laser and bipolar electrocoagulation is another another option to treat rhinophyma. This combined method provides a bloodless operative field which allows the sculpting of the hypertrophic areas, leading to a good cosmetic outcome and a pain-free postoperative recovery. In conclusion, it is important to diagnose rosacea at an early stage and treat it effectively before it has a chance to develop into rhinophyma and disfigure the patient’s nose and face.

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