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Thread: rhinophyma questions?

  1. #1
    Senior Member RedFaced's Avatar
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    Default rhinophyma questions?

    I am pretty sure I have the beginnings of this.

    My nose has been sore lately and when I wake up it is reddish and swollen (feels like I got a ball in the face if that ever happened to anyone in gym class). I have also noticed a small bump on one side of my nose just before the tip but on the side. It has been there for a few years and is not really coloured although when my nose gets reddish it does also get red.

    I don't know much about this and take it that this is the final stage of Rosacea so am wondering how I could have the beginings now...but I know Rosacea is not text book.

    Anyways here are my questions for anyone who can help.

    1. Accutane - I read that this is the best treatment. I was on Accutane for 8 months @ 40mg/daily and finished almost a year ago. Yes, during that time it did not bother me at all and my nose looked great and felt great. I cannot go on this drug again however, it made my flushing worse and I have dry skin still on my body from this medication. I am wondering though, if Accutane is the treatment of choice, does that mean that this will not develop too severely for me since I was on it for 8 months @ 40mg? Surely you cannot be on Accutane for good...and if Accutane shrinks the sebacous glands and hyperactive sebacous glands it was causes rhinophyma, then perhps it will not get too bad?

    2. Metrogel .75% - I just received this the other week and started using it on my nose. Will this help with early stages and/or preventing rhinophyma?

    3. What other medications are useful? I read Antibiotics are useful, is that true? I may ask for BActrim again. I was on antibiotics for a 2 years prior to Accutane and have given myself a much needed break from them these past few months.

    4. Any other treatments? I basically would like to prevent things from progressing any further as this can be really disfiguring (from images I have seen).

    5. I also had IPL a couple years back but that was also a bad idea and my skin did not react well to it, so lasers are out (also since I have only been off Accutane for 10 months and they say to wait at least 1 year).

    Thanks

  2. #2
    Moderator Melissa W's Avatar
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    Here is something from feedblitz that may help you:

    http://rosacea-support.org/how-to-cu...llen-nose.html

    The red swollen nose of rosacea is a much hated symptom. I know that this was the symptom that I despised most and indeed drove me 10 years ago to start to look for good information about how to treat rosacea. Incidentally, this drive lead to the creation of the internet based Rosacea Support Group in 1998.
    I hated that I looked like I had adult acne and a constant sun-burned nose. Especially as I have somewhat fair skin, a red nose stood out a mile away.
    There has been quite a lot of interest in a article I wrote titled ďhow to cure a red face (facial erythema or redness)ď. That article gave some tips on how to deal with general facial redness. What about a red and swollen nose ? What can you do to treat a red rosacea nose ? Read on for some suggestions.
    A rosacea nose has the extra complication that one might end up suffering from rhinophyma. Although rare, rhinophyma is also a much hated symptom of rosacea. While we donít know for sure how any particular rosacea suffererís symptoms will progress, reducing your inflammation and flushing is a good start to winning the battle.
    Here are my top tips for dealing with the red nose of rosacea.
    Rosacea-LTD III

    Rosacea-LTD was one of my first discoveries after starting to look for treatments on the internet in 1998. They consist of compressed disks of sulfur and various salts. You wet your face and glide them over the skin, leaving a thin film. For me these `disksí did a great job of reducing the papules and pustules on my nose. I could feel them shrinking all those acne looking lumps and bumps. As much of my redness was associated with my papules and pustules, this treatment was a good step in the right direction. I continued to use rosacea-ltd for several years.
    Disclaimer: rosacea-ltd is a site sponsor of rosacea-support.org
    Oral Antibiotics

    If the nasal swelling is associated with the papules and pustules normally seen in rosacea, then systemic antibiotics along with topical metrogel or finacea may also be of benefit. Once the papules and pustules are under control, the associated swelling may be reduced enough to see an overall benefit in appearance. One of the newer antibiotics on the market is a low dose form of doxycycline called Oracea, which may be useful in helping to maintain a long term benefit from antibiotic usage.
    Accutane

    Accutane or roaccutane has been used for many years to treat cystic acne. There is a good body of evidence to say that you can successfully treat rosacea with accutane. Additionally there are some published papers that deal specifically with treating rhinophyma with accutane.
    Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.
    Ö
    Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.
    Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change.
    [See treating rhinophyma with accutane]
    Accutane is not a drug to be taken lightly. If you would like to try this as an option, the above references might help you find a doctor that can support you using this as a treatment option. You may also want to discuss the option of low-dose accutane with your doctor.
    Covering Up

    As you start to reduce the inflammation, you will probably also benefit from covering over some of the redness. Some options include the easily available Clinique Redness Solutions, or Eucerin Redness Relief which may be able to offer some relief from the redness. Additionally the green tinted version of the Tone Perfecting Cream may cover some redness.

    Perhaps you can find some foundation or tinted moisturizer that you can also include in your daily regime. It might not be easily obtainable worldwide, but The Cancer Council in Australia has a range of tinted moisturiser SPF 25 that looks interesting. Donít discount a liquid foundation as a possibility, even if you are a guy.
    IPL and Lasers

    We now know that IPL is excellent for treating a red face and broken blood vessels. Will any of the benefits of IPL also help a red swollen nose ? In general IPL and pulsed dye lasers are useful in reducing the redness flushing, burning, itching, dryness and swelling of rosacea.
    The AAD suggests that for thickening of the skin on the nose and cheeks as seen in rhinophyma, the CO2 laser and erbium:YAG laser can be used.


    Surgical Options

    When the growth of the nose tissue becomes impossible to manage with topicals or isotretinion, surgical intervention can be an option. Surgery can naturally have its own risks. With the removal of extra tissue also comes the risk of scarring.
    CO2 Laser

    A 2004 paper; The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2 Laser, details how the authors suggest that the combined YAG/CO2 laser is superior to other lasers, scalpel, radiotherapy and skin grafts in dealing with rhinophyma.
    Also some related comments from the AAD page Is laser treatment right for your rosacea? ;
    Some patients with longstanding rosacea develop thickening skin on the nose and cheeks, which is called rhinophyma. The CO2 laser and erbium:YAG laser can be used to remove this thickening skin and improve the contour of the nose. Other surgical procedures used to treat this condition include dermabrasion and excision with a scalpel. Treatment options may be combined to obtain best results.
    Dermatologists recommend early treatment of rhinophyma to help prevent the condition from progressing and becoming more difficult to treat. In the advanced stages, rhinophyma can cause difficulty breathing through the nose. It also is possible for the nostrils to collapse.
    Other Surgical Methods

    A 2003 paper; New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal details a novel technique using a standard microdebrider followed by a haemostatic sealant to eliminate bleeding.

  3. #3
    Moderator Melissa W's Avatar
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    I am so sorry but I neglected to say that David Pascoe wrote all that info I posted from Feedblitz yesterday regarding rhinophyma and I am so appreciative of all the excellent work he does for all rosaceans! Thanks David...you are the best

    Best wishes,
    Melissa

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    Senior Member RedFaced's Avatar
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    Thanks for the info

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    Default Early Stages of Rhinophyma

    Hi,

    I am new to the group. I came across Redfaced's posting when I searched for Rhinophyma on the web. I was recently diagnosed with a mild case of Rosacea, but my nose is already in the early stages of rhinophyma. It was hard to believe in the beginning because there are very few female Rosaceans that experience this subtype of Rosacea, especially when I only in my early 30's and have a mild case. Unfortunately, my nose seems to be getting a little bigger each month and I am afraid that the condition will get worse if I don't start treatment. I am curious if anyone here with early stages of Rhinophyma found a good treatment for it. Also, if anyone knows of a good dermatologist in NYC who has an in-depth knowledge of Rosacea, please let me know.

  6. #6
    Senior Member queta's Avatar
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    Quote Originally Posted by Stefieny View Post
    Hi,

    I am new to the group. I came across Redfaced's posting when I searched for Rhinophyma on the web. I was recently diagnosed with a mild case of Rosacea, but my nose is already in the early stages of rhinophyma. It was hard to believe in the beginning because there are very few female Rosaceans that experience this subtype of Rosacea, especially when I only in my early 30's and have a mild case. Unfortunately, my nose seems to be getting a little bigger each month and I am afraid that the condition will get worse if I don't start treatment. I am curious if anyone here with early stages of Rhinophyma found a good treatment for it. Also, if anyone knows of a good dermatologist in NYC who has an in-depth knowledge of Rosacea, please let me know.
    Hi
    I am also a woman with phymatous rosacea. I get swelling of my nose, chin, cheeks, forehead, and eyelids. I have controlled it a lot through diet (no alcohol, no dairy, no sugar, no gluten, no citrus fruits.) Sometimes antihistamines help and other people have used IPL. You probably want to start a diary of what you're eating, etc and determine your triggers. Some people are also helped by taking a baby aspirin in the evening before bed. Feel free to ask more questions.
    Regards
    Queta
    "Do not go where the path may lead, go instead where there is no path and leave a trail."
    Ralph Waldo Emerson

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    Default Rhinophyma

    Hi Queta,

    Thanks for the advice.

    Unfortunately, it is nearly impossible for me to control the flushing because it gets red whenever I wash my nose. I saw Dr. Cohen this week and he prescribed Oracea. He said it will reverse my nose, so I will try and see if it works.

  8. #8
    Moderator Melissa W's Avatar
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    Hi Stefieny,

    You are in good hands with Dr Cohen and if the Oracea does not provide the relief you were hoping for he would prescribe Accutane if necessary. So don't worry. It will be OK.

    Best wishes,
    Melissa

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    Thanks Melissa!

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    Default Stefieny's question re rhynophyma

    Hi, I have had rhynophyma for a number of years. My nose was really big. Two months ago I finally put aside my principled aversion to antibiotics and started taking doxycline. Within around three weeks my nose had shrunk -- I look pretty normal now. I am much more confident (or less insecure) to see the least. Search this site for discussions of the drawbacks of long-term use of doxy -- which (or so I understand; please confirm for yourself) can be mitigated by taking a low-dose version called Oracea.

    As regards a good dermatologist in NYC -- well, I live in London now, but once when visiting NYC 10 years ago I saw Dr David Colbert. This was not rosacea related. But I will say he struck me as extremely competent. He correctly found that a cyst on my eyelid, which a UK GP had told me was harmless, was actually advanced skin cancer. A biopsy proved Dr Colbert to be correct, and I had immediate surgery. You might at least consider him.

    Good luck.

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