Rhinophyma

Description:

The rhinophyma is a tumorous high-quality change of skin of a nose which is shown by a hypertrophy of all elements of a nose that disfigures a human face. As all elements of skin increase, the size and width of channels of sebaceous glands are hypertrophied too. At a rhinophyma the strengthened sebaceous secretion is noted, fat accumulates in channels, decays owing to what there is an unpleasant smell.

Rhinophyma reasons:

The rhinophyma is an infiltrative and productive complication of a rozatse and is more often diagnosed for men is more senior than forty years. If in the anamnesis of the patient with a rhinophyma there is no rozatse or pink eels then it is considered as an individual disease.

The disease etiology is up to the end not studied, but to fluctuations of temperatures similar pathologies diagnose for people who are subject to a frequent overheat and overcooling, more often; the increased humidity or excessive dryness, and also dust content of air increase risk of emergence of a rhinophyma too.

Patients with a rhinophyma at the anamnesis usually have endocrine diseases, disturbances of a hormonal background, a digestive tract disease. A hypovitaminosis, stressful situations and errors in a diet in itself are not the main reason for a rhinophyma, but in combination with above-mentioned factors increase probability of its emergence.

There is no feedforward between a rhinophyma and an alcoholism, but considering that at alcoholism diseases of various bodies and systems join, the excessive use of alcoholic drinks and a rhinophyma are closely connected among themselves.

Inborn vascular changes of face skin and transformation of an inborn vascular nevus at most of patients lead to fimopodobny changes of face skin.

Rhinophyma symptoms:

Externally the rhinophyma looks as an outgrowth, it occurs at the expense of a hypertrophy and a hyperplasia of skin of a nose. The outgrowth can be single or in the form of nodes, then the knotty rhinophyma is diagnosed. Because of expanded vessels color of hypertrophied nodes can vary from red to dark brown and lilac shades.

Large sebaceous glands and follicles are corked with a keratin, the area struck with a rhinophyma represents lymphatic interfollikulyarny inflammatory infiltrate. If the rhinophyma progresses, then granulomas are observed and often huge sebaceous glands are emptied in a usual sine.

At a rhinophyma clearly it is visible that the most part of hypertrophied fabric consists of expanded vessels with thin walls. The skin affected with a rhinophyma is more subject to development of new growths.

The rhinophyma meets several versions. Grandulyarny forms diagnose more often, growths of skin of a nose in this case externally look as rough nodes. The consistence of nodes soft, and the surface of the site struck with a rhinophyma glossy grease with cyanotic and is more rare a lilac shade.

The fibrous form of a rhinophyma meets less often, at such form skin layers are also hypertrophied, but skin dense that keeps a nose configuration. A surface smooth, brilliant of enlarged pores release of skin fat which at interaction with air gets an unpleasant smell is possible. At a palpation the expressed hyperplasia of sebaceous glands of various density is felt.

The Fibroangiomatozny rhinophyma is clinically similar to a fibrous form of a rhinophyma, but at a palpation nodes more elastic and soft. At the expense of a large number of telangiectasias the surface of a nose has dark red coloring. Differentiate this form of a rhinophyma from the others on existence of a large number of superficial and deep pustules. Contents of pustules bloody and purulent which in process of evacuation shrinks in crusts. Patients in addition to the complicated breath show complaints to an itch, morbidity and parasthesias.

The actinic form of a rhinophyma has more high-quality current, layers of a derma are thickened evenly and slightly, the nose gets cyanotic coloring, telangiectasias are localized preferential on nose wings. At this form of a rhinophyma of a pustule are absent, and mouths of sebaceous glands are expanded slightly owing to what skin fat separates moderately without formation of crusts on the surface of a nose. The main pathogenetic component of an actinic rhinophyma is the actinic elastosis.

Current of a rhinophyma long, with series of stages of a zatikhaniye of process and stages of active growth. As a rule, the active growth of a rhinophyma is observed in the first years of a disease, in several years growth can stop completely, but involution of a rhinophyma is not observed.

The rhinophyma complicates nasal breath, and at the huge sizes and meal in spite of the fact that pathological process does not affect cartilages, pressure from the expanded rhinophyma upon them is so big that nasal cartilages are deformed or exposed to full destruction.

Diagnosis:

"Rhinophyma" the dermatologist usually puts the diagnosis on the basis of visual survey, history of a course of a disease and the anamnesis of life of the patient. When pressing from deeply involved mouths the white pasty secret is allocated. Results of the cytologic research separated allow to make precisely the diagnosis, at microscopy epithelial cells in a large number, skin fat, saprophytic microflora are found, pathogenic microflora can be present not always, presence of mites like демодекс is observed not always too.

Despite bright and specific clinical manifestations of a rhinophyma, it needs to be differentiated with a demodicosis as the rhinophyma can be complicated by a demodicosis, but the last is not the main pathogenetic mechanism; skin T-cellular lymphoma, a sarcoidosis and lymphatic leukemias can be shown by growths of skin tissue of nose too. Additional inspections, such as a biopsy of fabrics, with the subsequent histologic analysis help to exclude, or to confirm the diagnosis "Rhinophyma".

Treatment of a rhinophyma:

Therapeutic methods of a rhinophyma do not bring results, and therefore various methods of surgical treatment are used. Dermabrasion of the site of skin struck with a rhinophyma yields good results at insignificant growths of fabrics and in initial stages of a disease.

Hypodermic excision of the expanded fabrics and wedge-shaped excision of the sites struck with a rhinophyma with imposing of intradermal seams are shown at deep damages of skin of a nose and at impossibility of use of other techniques of surgical treatment of a rhinophyma.

Laser therapy of a rhinophyma in the course of treatment allows to model the disfigured shapes of a nose, that is is reached therapeutic and esthetic effects. If the rhinophyma struck the insignificant site, then removal is shown by the laser of the expanded derma. Process of epithelization occurs in 7-10 days after the procedure.

The radio wave method in treatment of a rhinophyma allows to eliminate quickly and effectively all clinical manifestations and to get into condition a nose. At such treatment there is practically no blood loss, there are no hypostases, the probability of postoperative complications is minimum, and process of rehabilitation is short.

Sometimes, at layer-by-layer excisions of a rhinophyma patients need a rhinoplasty to recover its form and to achieve esthetic outward. But a main issue in therapy is partial removal of externally not changed fabrics to reduce probability of a recurrence of a rhinophyma. At correctly performed operation a recurrence arises only at several percent of patients.

Prevention of a rhinophyma:

There is no specific prevention of a rhinophyma, but timely treatment of pink eels and a rozatse reduce risk of emergence of a rhinophyma. After surgical treatment of a rhinophyma patients should avoid sharp differences of temperatures, to reconsider a diet and if it is required, then to replace the place of work.