Rhinophyma — SCE Dermatology MCQ

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ModerateDermatological SurgeryRhinophymaSCE Dermatology

A 45-year-old woman with rosacea develops rhinophyma. She has progressive thickening and lobulation of the nasal skin with prominent sebaceous glands. What is the most appropriate treatment for established rhinophyma?

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Correct answer: A — Surgical reduction (laser ablation, electrosurgery, or excision)

Established rhinophyma (subtype 3 rosacea — phymatous) with tissue hypertrophy does not respond to medical therapy (topical or oral medications cannot reverse the fibrous and glandular hyperplasia). Surgical reduction is the treatment of choice, using CO₂ laser ablation, electrosurgery/loop cautery, dermabrasion, or excision to reduce the excess tissue back to normal nasal contour. The tissue re-epithelialises from follicular structures. Oral Isotretinoin may help reduce sebaceous gland activity early in the process but cannot reverse established hypertrophy. Medical therapy (Doxycycline, topical agents) is used for the inflammatory papulopustular component of rosacea that often coexists.

Reference: BAD 2021 Rosacea Guidelines; NICE CKS