isotretinoin and Rhinophyma

Rosacea, a common disease in adults, has an extremely variable presentation. Severity is also highly variable and, to some degree, the location of mild end of the rosacea spectrum is in the eye of the beholder. Rosacea has been noted since at least the Middle Ages. The red-faced drunk and the swollen nose of the self-indulgent are images from Shakespeare and Chaucer that have been used in modern political cartoons as well. This association with alcohol and excess is unfortunate since most patients are neither alcoholic nor dissipated.

Topics: Anti-Bacterial Agents; Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Rhinophyma; Rosacea

Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple therapeutic options.

Topics: Adult; Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Cathelicidins; Dermatologic Agents; Diagnosis, Differential; Disease Models, Animal; Female; Humans; Isotretinoin; Male; Mice; Niacinamide; Rhinophyma; Risk Factors; Rosacea; Skin; Telangiectasis; Ultraviolet Rays

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously.

Topics: Anti-Bacterial Agents; Chronic Disease; Dermatologic Agents; Eye Diseases; Humans; Isotretinoin; Prognosis; Rhinophyma; Rosacea; Sunscreening Agents

Rhinophyma, a rare and progressive disfiguring condition, is thought to be the final stage of rosacea. Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser. The last 2 techniques are the most effective for the management of rhinophyma. We describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolivar and in private clinics in Bogota, Colombia, between 2012 and 2016. The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. Three patients presented hypertrophic scars that were treated with steroid injections and silicone gel sheeting. Two patients presented persistent erythema. However, there were no serious infections and none of the patients required further surgery. Electrosurgery is one of the simplest and most cost-effective techniques currently available for the treatment of rhinophyma by dermatologists.

Topics: Adrenal Cortex Hormones; Adult; Aged; Cicatrix, Hypertrophic; Combined Modality Therapy; Dermabrasion; Electrocoagulation; Electrosurgery; Esthetics; Female; Humans; Isotretinoin; Male; Middle Aged; Patient Satisfaction; Rhinophyma; Silicone Gels; Treatment Outcome

Rhinophyma is a form of rosacea and is often cosmetically disfiguring. There are various therapeutic ablation modalities. Surgery is often associated with down-time and side-effects. We describe successful treatment with low-dose isotretinoin as a safe alternative with a lower risk of complications. We also discuss the advantages and disadvantages of various therapeutic modalities.

Topics: Dermatologic Agents; Humans; Isotretinoin; Rhinophyma; Rosacea

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Child; Contraindications; Dermatologic Agents; Doxycycline; Female; Humans; Isotretinoin; Laser Therapy; Male; Metronidazole; Rhinophyma; Rosacea; Sunscreening Agents

Topics: Adult; Diagnosis, Differential; Humans; Isotretinoin; Male; Rhinophyma

On the basis of a case of their own, the authors report on the evolution of a rhinophyma. Therapeutic results obtained with conservative treatment were not satisfactory. In contrast, a combination of surgical removal of the skin changes and systematic treatment with isotretinoin was associated with good results. Contraindications and possible side effects must always be borne in mind.

Topics: Combined Modality Therapy; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Rhinophyma; Rhinoplasty

Thirteen patients with severe rosacea (rosacea papulopustolosa, rosacea conglobata, and rhinophyma) were treated orally with 0.05, 0.5, or 1.0 mg/kg body weight 13-cis-retinoic acid (isotretinoin, Ro 4-3780) for 12-28 weeks. All patients had been treated previously with high doses of tetracyclines, metronidazole, or dermabrasion, etc., with no or only limited success. The therapeutic effect following 13-cis-retinoic acid was excellent. Inflammatory lesions regressed by 50% within 2 weeks, and by over 95% within 8 weeks. 13-cis-retinoic acid acts as a potent anti-inflammatory and sebum-suppressive agent. Besides papulopustules, nodules, and hemorrhagic abscesses, the inflammatory plaques and facial edema, but to a lesser extent teleangiectasias and the chronic conjunctivitis disappeared. The severe seborrhea disappeared. Long-lasting remission, similar to patients with severe acne being treated with 13-cis-retinoic acid, can be expected, as the first patients are in full remission for over 12 months at the time of writing. Exfoliative cheilitis occurred in every patient. Serum lipids increased only slightly. For female patients a reliable contraception is mandatory as teratogenicity cannot be excluded in this drug (similar to all retinoids).

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Isotretinoin; Male; Middle Aged; Rhinophyma; Rosacea; Skin; Tretinoin