phenylephrine-hydrochloride and Rosacea

Rhinophyma is a disfiguring disorder that is characterized by an erythematous, hypertrophied, and inflamed lower two-thirds of the nose. Widely accepted as the severe form of acne rosacea, rhinophyma can result in functional, aesthetic, and psychosocial concerns that require treatment in a cosmetic fashion. Rosacea should be treated in its earliest manifestations to mitigate the progression towards rhinophyma; therefore, early detection and intervention is a crucial part of treatment. Little has been written on this subject in people of color. We present the first reported case of rhinophyma in a 62-year-old Fitzpatrick V female patient who was successfully treated with one session of fractional CO2 laser resurfacing. This case highlights the successful use of the fractional CO2 laser to treat rhinophyma in darker skin types (Fitzpatrick IV–VI) and underscores the potential for future use among patients of color. J Drugs Dermatol. 2021;20(7):772-775. doi:10.36849/JDD.C702.

Topics: Esthetics; Female; Humans; Lasers, Gas; Middle Aged; Nose; Rhinophyma; Rosacea

Rhinophyma is a benign disease involving the skin of the nose, which is characterized by skin thickening and hypertrophy of the sebaceous glands and connective tissue. It occurs predominantly by Caucasians in their fifth to seventh life decades and is 12-30 times more likely to affect males. The etiology and pathogenesis of Rhinophyma remains unclear, however it is generally stated to be the final stage of rosacea. A causative relationship between rhinophyma and alcohol consumption has not yet been proven. This review highlights the treatment options of rhinophyma. Surgery is gold standard for management of advanced rhinophyma. Each technique has pros and cons, but using surgical instruments with monopolar energy as loop and ball electrode seem to combine several goals best - first of all simultaneous removal and hemostasis followed by nasal contour refinement. Due to possible coincidence of skin cancer such as a basal- or squamous cell carcinoma, histopathological examination of all removed tissue is recommended.. Als Rhinophym wird eine benigne Hautveränderung der äußeren Nase bezeichnet, die durch eine Hypertrophie der Talgdrüsen gekennzeichnet ist. Betroffen sind meistens männliche Kaukasier zwischen der 5. und 7. Lebensdekade. Die Ätiologie der Erkrankung ist bisher nicht vollständig geklärt, sie wird jedoch als Spätstadium der Acne rosacea betrachtet. Ein äthyltoxischer Zusammenhang, wie bisher vermutet wurde, ist bis dato nicht belegt worden. Der Artikel gibt einen Überblick über mögliche operative und konservative Therapieansätze. Die chirurgische Therapie stellt dabei den Goldstandard dar. Dabei erweist sich der Einsatz der Elektroschlinge zur subtilen Resektion und die Verwendung der monopolaren Kugel zur Feinmodulation als besonders vorteilhaft. Aufgrund einer möglichen Koinzidenz des Basalzell- oder Plattenepithelkarzinoms im Rhinophymgewebe, erscheint eine histopathologische Aufarbeitung des abgetragenen Gewebes sinnvoll.

Topics: Humans; Hypertrophy; Male; Nose; Rhinophyma; Rosacea; Skin Neoplasms

Topics: Acne Vulgaris; Adult; Carcinoma, Basal Cell; Dermatitis; Diagnosis, Differential; Erythema; Exanthema; Eye Manifestations; Female; Humans; Lupus Vulgaris; Male; Middle Aged; Nose; Rosacea; Sarcoidosis; Skin Neoplasms; Telangiectasis

To study the effect of laser treatment on rosacea, a common facial skin disease with symptoms of blushing, redness, telangiectasis, papules, pustules, and diffuse swelling of the skin, we focused on the stinging sensation and performed immunohistochemical evaluation of nerve density and neuropeptide expression.. Clinical investigation as well as the lactic acid (stinger) test was performed before and 3 months after the treatment with flashlamp pulsed dye laser, when skin biopsy specimens were also taken.. University hospital.. Thirty-two patients with rosacea, all with positive results from the lactic acid "stinger" test, were treated by flashlamp pulsed dye laser.. The biopsy specimens were taken from the stinger-positive areas in the nasolabial folds, fixed in Lanas fixative (10% formalin and 0.4% picric acid), and analyzed for the expression of protein gene product 9.5 (general nerve marker), substance P, calcitonin gene-related peptide, and vasoactive intestinal polypeptide, using a biotinylated streptavidin technique.. Thirty-one patients who were stinger positive before treatment showed decreased scores after treatment, and 1 patient had the same stinger test score before and after treatment. The number of protein gene product 9.5-positive fibers in the epidermis (P< .05) as well as the papillary dermis (P< .01) was decreased. This was also the case for substance P in the papillary dermis (P< .001), whereas no evident difference was noted for vasoactive intestinal polypeptide and calcitonin gene-related peptide. No difference was found for contact between nerves and vessels (factor VIII positive).. Laser treatment of rosacea that destroys small vessels has a good medical relevance because it reduces the unpleasant symptoms of the sensitive skin. A neurogenic etiology of stinging may be possible.

Topics: Adult; Aged; Calcitonin Gene-Related Peptide; Dermis; Epidermis; Female; Humans; Immunohistochemistry; Lactic Acid; Laser Therapy; Lip; Male; Middle Aged; Nose; Rosacea; Substance P; Ubiquitin Thiolesterase; Vasoactive Intestinal Peptide

Phymatous rosacea is a rare and severe form of rosacea that manifests as disfiguring soft-tissue hypertrophy and sebaceous gland hyperplasia and fibrosis. Most cases are surgically treated; surgical modalities vary, however, ranging from cryosurgery to conventional excision, and consensus guidelines for surgical management do not exist. The Versajet II Hydrosurgery System (Smith-Nephew) is a high-pressure, pulsatile lavage system. We present the case of a 75-year-old man with severe phymatous rosacea of the nose, cheeks, and chin who was successfully treated with the Versajet II Hydrosurgery System, yielding excellent contouring.

Topics: Aged; Cheek; Chin; Equipment and Supplies; Humans; Male; Nose; Rosacea; Severity of Illness Index; Treatment Outcome

Rosacea is characterized by erythema on face, especially erythema and linear telangiectasia on the nose. Currently, various vascular lasers are used for treatment, and among them, are long-pulsed Nd:YAG(LPNY) and pulsed dye laser (PDL).. This study compared the efficacy of LPNY and PDL in treating rosacea-associated nasal telangiectasia.. Patients with rosacea who showed erythema and telangiectasia on the nose were included. Each patient was treated with PDL on the left side of the nasal bridge, and LPNY on the right side, three times with 4-week intervals. At the end of the treatment, two independent dermatologists evaluated overall treatment response compared with baseline.. The physician's assessment of treatment concluded that good improvement was seen in six PDL and seven LPNY patients, and excellent improvement five PDL and four LPNY patients. There was no significant difference (p = 0.62, 95%CI) between the groups. Overall improvement was similar; however, LPNY induced a greater response in thick, dilated vessels, while erythema with mild telangiectasia was more responsive to PDL.. Both LPNY and PDL are effective in treating rosacea-associated nasal telangiectasia. If LPNY is used properly to avoid side effects with careful consideration, it can also be used as a good modality.

Topics: Adult; Aged; Erythema; Facial Dermatoses; Female; Humans; Lasers, Dye; Lasers, Solid-State; Low-Level Light Therapy; Male; Middle Aged; Nose; Rosacea; Telangiectasis; Treatment Outcome

Rosacea is an irritating disease that affects patients' health and life quality. The current treatments for rosacea have limited efficacy and are generally not satisfying most patients. This report presents a patient diagnosed with rosacea who was treated with acupuncture to a satisfactory effect. Laser Doppler was used to measure the local blood perfusion of the nose before, during, and after acupuncture treatment. The Dermatology Life Quality Index (DLQI) was used to measure the impact of rosacea on the quality of the patient's life.. A 52-year-old woman had been diagnosed with rosacea 18 months before this study. She had tried medical treatments in other hospitals with metronidazole cream, antifungal drugs, and steroidal ointments, but the effect was poor and limited.. In this study, the diagnosis of rosacea (stage I, subtype Erythematotelangiectatic) was made by a dermatologist according to physical examination).. The patient's treatment included a half-hour of acupuncture 3 times per week.. The patient experienced significant improvements in the region around the nose after 3 sessions of acupuncture treatment within the first week and reported that there was no relapse for 6 months after acupuncture treatment. The perfusion of blood flow was redistributed during and after acupuncture treatment according to laser Doppler measurements. The patient's DLQI score substantially improved. The patient was generally satisfied with the acupuncture treatment.. The results suggested that acupuncture might be an alternative therapy for facial localized rosacea. As well, acupuncture may be effective in treating rosacea through redistributing micro-circulation of blood at the localized area of effect. The overall costs of the rosacea treatment may be reduced, provided that this therapy is demonstrated to be effective in future controlled studies.

Topics: Acupuncture Therapy; Female; Humans; Microcirculation; Middle Aged; Nose; Quality of Life; Rosacea; Skin; Treatment Outcome

Topics: Adolescent; Adult; Contraindications, Procedure; Female; Humans; Male; Nose; Patient Care Planning; Reoperation; Rhinoplasty; Rosacea; Skin; Subcutaneous Tissue; Ultrasonography

Rosacea fulminans is a rare disorder of unknown cause, almost exclusively affecting women. There are only a few reported cases in men. The condition is characterized by the abrupt onset of pustules and nodules predominantly affecting the cheeks or chin without any systemic upset. We report the case of a 37-year-old man who presented with papulopustules, predominantly localized to his nose. Histopathological features were consistent with rosacea fulminans. The patient was managed with treatments including oral prednisolone, isotretinoin, and trimethioprim.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Dermatologic Agents; Drug Therapy, Combination; Facial Dermatoses; Humans; Isotretinoin; Male; Nose; Prednisolone; Rosacea; Trimethoprim

Topics: Facial Dermatoses; Female; Humans; Middle Aged; Nose; Rosacea; Sporotrichosis

Topics: Aged; Antineoplastic Agents; Docetaxel; Facial Dermatoses; Humans; Incidental Findings; Male; Middle Aged; Nose; Nose Diseases; Recurrence; Remission, Spontaneous; Rosacea; Taxoids; Telangiectasis

B-cell chronic lymphocytic leukemia (B-CLL) is a low-grade lymphoproliferative disease. Cutaneous involvement of B-CLL is limited and, in most cases, it represents non-specific manifestations related to an impaired immune system. Leukemic skin infiltrates (leukemia cutis) occur in 4-20% of patients. Herein we report the case of a 65-year-old woman with B-CLL presenting with papular, nodular, and plaque skin infiltrates affecting the nose, mimicking granulomatous rosacea. We discuss several aspects of rare cutaneous manifestations of B-CLL involving the face.

Topics: Aged; Diagnosis, Differential; Female; Hematologic Neoplasms; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphocytes; Nose; Rosacea

A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC, urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal. Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid granulomas are seen on histology examination. We herein report the case because it presented in atypical fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid persistent facial edema of rosacea (rosacea lymphedema).

Topics: Anti-Inflammatory Agents; Dermatologic Agents; Diagnosis, Differential; Facial Dermatoses; Humans; Isotretinoin; Male; Middle Aged; Nose; Prednisolone; Rosacea

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Antineoplastic Agents; Female; Humans; Immunohistochemistry; Interferon-gamma; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Minocycline; Nose; Recombinant Proteins; Rosacea; Skin Neoplasms

Topics: Adult; Anti-Infective Agents; Dapsone; Humans; Male; Nose; Rosacea; Skin; Staphylococcus aureus; Treatment Outcome

Rhinophyma is an uncommon disease of the nose characterized by irregular skin thickening and nodular deformation. The extensive growth causing 'whisky nose' is due to hyperplasia of the sebaceous glands and the surrounding connective tissue. Other facial regions may concomitantly be affected. We present a case of extensive gnathophyma accompanying minor lesions of the nose. Surgical treatment led to an excellent cosmetic result.

Topics: Aged; Chin; Humans; Hypertrophy; Male; Nose; Rhinophyma; Rhinoplasty; Rosacea; Sebaceous Glands; Surgery, Plastic

A 72-year-old retired truck driver presented with a 10-year history of rhinophyma and was successfully treated with 90-kV photons to a total dose of 40 Gy in 20 daily fractions. A brief discussion of radiotherapy in the treatment of rhinophyma follows.

Topics: Aged; Diagnosis, Differential; Humans; Male; Nose; Photons; Radiation Dosage; Radiotherapy; Rosacea

A case of folliculosebaceous cystic hamartoma associated with rosacea is presented. Clinically, a solid, 5-mm-sized nodule was observed on the nose which showed telangiectasia and a waxy appearance. Histologically, a large horn cyst was located in the dermis, and was continuous with the surface epidermis. It was associated with mature sebaceous glands and immature hair follicles. Folliculosebaceous cystic hamartoma and similar cases have recently been reported, but this is the first report accompanied by rosacea.

Topics: Cysts; Female; Hair; Hamartoma; Humans; Middle Aged; Nose; Rosacea; Sebaceous Glands; Skin Diseases

Ten patients with red nose due to telangiectasias were treated with the argon laser. Seven had telangiectasias due to rosacea, two had had rhinoplasty, and one had experienced trauma. All of the patients had a good clinical result.

Topics: Aged; Female; Humans; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Rhinoplasty; Rosacea; Telangiectasis

Topics: Aged; Esthetics; Humans; Male; Nose; Rhinophyma; Rosacea; Skin Transplantation

For years cosmetic surgeons have sought methods of treatment of large rhinophyma. These include creation of flaps with excision of excess skin, dermabrasion, free-hand shave, and others. The CO2 laser has been used by itself, or in combination with other methods to vaporize the rhinophyma. Advantages of the the laser include hemostasis, better view of the tissues, thin layer-by-layer removal of the hyperplastic sebaceous glands, and careful shaping of the resection edges. Disadvantages include risk of facial burns and overabundant removal of tissue with cartilage exposure. We present a case of rhinophyma excision using the CO2 laser and the complication of excessive vaporization of the sebaceous tissue. Included is a discussion of other complications of laser excision of rhinophyma, possible methods of reconstruction, and a literature review.

Topics: Aged; Humans; Laser Therapy; Male; Nose; Reoperation; Rhinophyma; Rosacea; Surgical Flaps; Wound Healing

Topics: Cryosurgery; Humans; Middle Aged; Nose; Rhinophyma; Rosacea

Nasal telangiectasias, a common condition, can be caused by chronic exposure to ultraviolet light, rosacea, topically applied corticosteroids, or rhinoplasty. Use of the argon laser for 15 to 45 minutes in a continuous mode over the entire involved area can produce considerable lightening of the nasal redness and improvement in the cosmetic appearance, as illustrated in the two cases described in this report.

Topics: Follow-Up Studies; Laser Therapy; Male; Nose; Nose Diseases; Rhinoplasty; Rosacea; Telangiectasis

Topics: Diagnosis, Differential; Humans; Male; Middle Aged; Nose; Rhinophyma; Rosacea; Tomography, X-Ray Computed

Prior to anticipated nasal surgery, the nasal and facial skin should be examined for any vascular lesions. The skin type should be ascertained. A history of any prior nasal surgery, particularly on the nasal dorsum, should be noted. If rosacea is a clinical possibility, a trial of 1.5 to 2.0 gm q.d. of tetracycline for 6 to 8 weeks is warranted. If, after rhinoplasty, a diffuse "redness" on the nasal dorsum results and one can exclude other diagnoses, then argon laser therapy should be considered. A 3-mm punch biopsy should be obtained to see whether superficial ectatic vessels are present, a finding that would be indicative of a good result from laser therapy.

Topics: Diagnosis, Differential; Erythema; Female; Humans; Laser Therapy; Middle Aged; Nose; Rhinoplasty; Rosacea; Skin; Telangiectasis

Surgery is the generally accepted treatment for rhinophyma. Problems associated with standard therapy include moderately profuse hemorrhage impairing accurate removal, and some difficulty in providing smooth demarcation between the rhinophyma and the surrounding tissue. Four patients with rhinophyma have been successfully treated with the carbon dioxide laser. Satisfactory cosmetic results were achieved in all cases with excellent hemostasis and minimal morbidity. Complete healing takes three to four weeks, which is similar to conventional methods.

Topics: Aged; Carbon Dioxide; Humans; Laser Therapy; Male; Methods; Nose; Rhinophyma; Rosacea

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nose; Postoperative Complications; Rhinophyma; Rhinoplasty; Rosacea; Skin Transplantation; Transplantation, Autologous

A case is presented in which angiosarcoma of the nose was found in a patient with rhinophyma. To the best of our knowledge, this constellation has not previously been reported.

Topics: Aged; Hemangiosarcoma; Humans; Male; Nose; Nose Neoplasms; Rhinophyma; Rosacea

Topics: Humans; Nose; Rhinophyma; Rosacea; Skin Transplantation; Transplantation, Autologous

Fifteen patients with rhinophyma were treated surgically by cutting off the hyperplasia nodules with a scalpel followed by shaving with a disposable shaving razor. The cosmetic results were good and no scar formation occurred.

Topics: Dermatologic Surgical Procedures; Humans; Lip; Male; Nose; Rhinophyma; Rosacea; Surgery, Plastic

Topics: Collagen Diseases; Diagnosis, Differential; Female; Humans; Male; Nose; Rhinophyma; Rosacea; Skin Diseases; Skin Diseases, Infectious; Skin Manifestations

Topics: Cerebrospinal Fluid Rhinorrhea; Cryosurgery; Epistaxis; Fractures, Bone; Histiocytoma, Benign Fibrous; Humans; Mucous Membrane; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Nose Diseases; Nose Neoplasms; Rhinitis; Rhinoplasty; Rosacea; Skin Neoplasms

Topics: Aged; Cryosurgery; Humans; Male; Nose; Rosacea

Topics: Adolescent; Adult; Anesthesia, Local; Electrosurgery; Female; Humans; Male; Middle Aged; Nose; Rosacea; Skin Transplantation; Transplantation, Autologous

Topics: Facial Dermatoses; Humans; Nose; Rosacea

Topics: Dermabrasion; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Nose; Postoperative Care; Rosacea; Wound Healing

Topics: Aged; Humans; Male; Nose; Rosacea; Skin Diseases

Topics: Adult; Biopsy; Connective Tissue; Dilatation; Facial Dermatoses; Female; Humans; Male; Middle Aged; Mite Infestations; Nose; Rosacea; Skin; Skin Diseases; Sunburn

Topics: Humans; Male; Methods; Nose; Rosacea

Topics: Epidermis; Geriatrics; Humans; Nose; Pathology; Rhinophyma; Rosacea; Skin Transplantation; Surgical Procedures, Operative; Transplants

Topics: Geriatrics; Humans; Nose; Rhinophyma; Rhinoplasty; Rosacea

Topics: Burns; Dermabrasion; Ear Deformities, Acquired; Ear, External; Humans; Nose; Nose Deformities, Acquired; Rosacea; Surgery, Plastic

Topics: Animals; Humans; Hydrozoa; Nose; Rosacea; Tuberculosis, Cutaneous

Topics: Animals; Humans; Hydrozoa; Lupus Erythematosus, Systemic; Nose; Rosacea; Telangiectasis