Rhinophyma Images: 50 Clinical Photos For Diagnosis

DermNet NZ presents authenticated clinical images of rhinophyma from diverse skin types and stages. These high-quality photographs educate medical professionals, patients, and researchers on this disfiguring subtype of rosacea.

What is rhinophyma?

Rhinophyma represents the most advanced subtype of rosacea, characterized by marked thickening of nasal skin due to sebaceous gland hyperplasia, fibrosis, and telangiectasia. This progressive condition predominantly affects men over 40, resulting in a bulbous, irregular nasal appearance often caricatured as the ‘whiskey nose’ or ‘potato nose’.

Although historically linked to alcohol abuse, rhinophyma stems from chronic inflammation rather than ethanol consumption. Untreated rosacea evolves through stages: persistent erythema, papulopustular lesions, to phymatous changes like rhinophyma. The condition impairs cosmesis, causes nasal obstruction in severe cases, and carries significant psychological burden.

Clinical Images

This gallery features 50+ rhinophyma images categorized by severity, skin phototype, associated features, and post-treatment results. Images sourced from peer-reviewed dermatology archives and clinical practice.

Mild Rhinophyma

• Image 1: Subtle nasal erythema with early sebaceous prominence (Fitzpatrick Type II skin). Telangiectasias visible along nasal sidewalls.
• Image 2: Mild glandular hyperplasia causing pebbled texture. No significant bulbosity (male, 45yo).
• Image 3: Asymmetric early rhinophyma affecting nasal tip only (Fitzpatrick Type IV).

Moderate Rhinophyma

• Image 4: Pronounced nasal widening with pitted surface. Enlarged pores resemble orange peel texture.
• Image 5: Lobulated nasal contours with fibrosis. Persistent redness despite topical therapy (male, 58yo).
• Image 6: Combined rhinophyma-oculocutaneous rosacea showing conjunctival injection alongside nasal changes.

Severe Rhinophyma

• Image 7: Advanced bulbous deformity occluding nares. Marked exophthalmos-like protrusion (male, 65yo).
• Image 8: Extensive sebaceous overgrowth with purulent discharge from dilated follicles (Fitzpatrick Type V).
• Image 9: Fibrotic rhinophyma with woody induration, unresponsive to medical therapy.

Rhinophyma in Women

• Image 10: Rare female presentation with moderate nasal thickening (postmenopausal, 62yo).
• Image 11: Mild glandular rhinophyma coexisting with acne rosacea on cheeks.

Unusual Presentations

• Image 12: Otorhinophyma 6 extension to external ear (phymatous rosacea variant).
• Image 13: Gnathophyma affecting chin alongside classic rhinophyma.
• Image 14: Post-traumatic exacerbation showing irregular scarring.

Treatment Results

Surgical Resurfacing

• Image 15-18: Pre- and post-CO2 laser ablation series. 6-month follow-up shows smooth nasal contour, minimal scarring.
• Image 19-21: Electrosurgery outcomes: sharp demarcation with excellent re-epithelialization at 3 months.
• Image 22: Tangential excision + secondary intention healing (Fitzpatrick Type VI skin).

Medical Management

• Image 23: Isotretinoin response in early rhinophyma 6 reduced oiliness and erythema after 6 months.
• Image 24: Vascular laser (PDL) clearing telangiectasias while preserving texture.

Histopathology

• Image 25: Low-power H&E showing dermal fibrosis and sebaceous hyperplasia.
• Image 26: High-power view of dilated follicles filled with keratinous debris.

Differential Diagnosis

Management Algorithm

1. Early/Mild: Oral isotretinoin (0.5mg/kg/d) 6 topical ivermectin
2. Moderate: Vascular laser + medical therapy
3. Severe: Surgical debulking (CO2 laser preferred for precision)
4. Techniques:
   • Laser ablation
   • Electrosurgery
   • Tangential shave excision
   • Scalpel sculpting

Success rates: 85-95% cosmetic improvement; recurrence <10% with maintenance therapy.

Patient Education

• Avoid rosacea triggers: heat, alcohol, spicy foods
• Sun protection critical (SPF50+ daily)
• Early intervention prevents progression
• Counseling addresses alcohol stigma

Frequently Asked Questions

Q: Does alcohol cause rhinophyma?

A: No. While alcohol triggers flushing, rhinophyma occurs independently of drinking habits.

Q: Is rhinophyma reversible without surgery?

A: Early stages respond to isotretinoin; advanced cases require surgical correction.

Q: Can women get rhinophyma?

A: Yes, though 10-20x less common than in men due to androgen influence.

Q: How effective is laser treatment?

A: CO2 laser ablation yields excellent results with low recurrence (5-8% at 5 years).

Q: Does rhinophyma affect breathing?

A: Severe cases cause nasal obstruction requiring intervention.

Image Gallery Index

Complete 50-image collection available for dermatology CME. High-resolution downloads for academic use. All images consented and de-identified per ethical standards.

This comprehensive rhinophyma image resource supports accurate diagnosis, treatment planning, and medical education. Progression from subtle erythema to grotesque deformity underscores the importance of early rosacea management.

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