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Thread: Phymatous Rosacea - Interesting Comment from the Jedi Master

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    Senior Member J-Mill's Avatar
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    Default Phymatous Rosacea - Interesting Comment from the Jedi Master

    Saw this quote from Bikowski, thought it was interesting:

    For instance, Dr. Joseph Bikowski, a clinical assistant professor of dermatology at the Ohio State University who practices at the Bikowski Skin Care Center in Sewickley, believes that phymatous rosacea, which can produce rhinophyma, or the so-called W.C. Fields nose, is not rosacea but a separate disease. The reason: "I've seen over 72,000 patients over 450,000 patient visits and never seen it in a woman," Dr. Bikowski said.
    "Get busy living or get busy dying."

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    Moderator Melissa W's Avatar
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    My laser derm says the same thing that she never has seen rhinophyma in a woman but we have a couple of women here at RF who do have it so I just dismissed that as my derm being ignorant about this specific topic.
    Not sure about Dr Bikowski though...


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    That quote is from an old article in the Pittsburgh newspaper. (Sewickley being a suburb or Pittsburgh, Pennsylvania).

    I did a little bit of research on the guy and office awhile back. I think the math is fuzzy. Assuming 450,000 visits- 15 minutes per visit, the math doesn't work. Assuming only 15 minutes per visit, that's 112,500 hours. Assuming 40 hour work weeks, that's 2,812.5 total weeks or 54 years working 52 weeks a year, no days off. That's hard to believe. The guy isn't a hundred years old.

    I don't think we yet have a woman diagnosed with textbook rhynophyma. My two derms have told me the same thing- they have never seen it in a woman. Nor can anyone produce a photo of true rhynophyma in a woman in any text, etc. If it does exist in females, it must be unbelievably rare.

    All that said and despite the good doctor's fuzzy math, I believe he is correct. I have met people that have rhynophyma with absolutely NO signs of rosacea. None. So, while it may be a related disease, I believe there may be some truth in his thoughts.

    This is the full article...
    http://www.post-gazette.com/pg/08016/849382-114.stm

    Rob
    Last edited by boyandhisdog; 10th March 2009 at 12:30 PM.

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    Senior Member J-Mill's Avatar
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    Quote Originally Posted by boyandhisdog View Post
    That quote is from an old article in the Pittsburgh newspaper. (Sewickley being a suburb or Pittsburgh, Pennsylvania).

    I did a little bit of research on the guy and office awhile back. I think the math is fuzzy. Assuming 450,000 visits- 15 minutes per visit, the math doesn't work. Assuming only 15 minutes per visit, that's 112,500 hours. Assuming 40 hour work weeks, that's 2,812.5 total weeks or 54 years working 52 weeks a year, no days off. That's hard to believe. The guy isn't a hundred years old.

    Rob
    Maybe he is counting every 15 minute time block you wait in the packed waiting room for 1-2 hours (at least) past your appointment time as 1 visit. Therefore, it is theoretically possible to have 5-9 visits per trip to his office.

    BTW: Little known fact, Sewickley's town motto is: 'Where we defy the laws of time and space', so it is possible.
    "Get busy living or get busy dying."

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    Hey J,
    What is your take on the rhinophyma thought though? Just because Dr. Bikowski and Marty have clearly broken the time/space continuim and he is driving around in a tricked out Delorean doesn't necessarily mean he is incorrect in his line of thought.

    Seperate but related disease? More common (like say seb derm) in rosaceans? What say you- Dr. B's delusions of grandeur aside.

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    Senior Member J-Mill's Avatar
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    Quote Originally Posted by boyandhisdog View Post
    Hey J,
    What is your take on the rhinophyma thought though? Just because Dr. Bikowski and Marty have clearly broken the time/space continuim and he is driving around in a tricked out Delorean doesn't necessarily mean he is incorrect in his line of thought.

    Seperate but related disease? More common (like say seb derm) in rosaceans? What say you- Dr. B's delusions of grandeur aside.
    "Get busy living or get busy dying."

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    Senior Member J-Mill's Avatar
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    Default Take 2

    Quote Originally Posted by boyandhisdog View Post
    Hey J,
    What is your take on the rhinophyma thought though? Just because Dr. Bikowski and Marty have clearly broken the time/space continuim and he is driving around in a tricked out Delorean doesn't necessarily mean he is incorrect in his line of thought.

    Seperate but related disease? More common (like say seb derm) in rosaceans? What say you- Dr. B's delusions of grandeur aside.
    I don't know what happened there...

    Anywho, my take is it is a related disease process to Rosacea. In brief I believe that the inflammation from Rosacea combines with too much testosterone causing the sebaceous glands to say "supersize me" leading to the hypertrophy of the glands and thus the growths seen in rhinophyma.

    It is at the very least a male dominated disease. I haunt this board like a poltergeist, read many, many, many studies/text excerpts/articles and I have never seen or heard of a woman with genuine rhinophyma. To be sure they get swelling in the nose, but unless your nose looks similar to this:



    it is not rhinophyma, the nodular bumps is what separates it.

    It is possible that women may get this disease and if so, antiandrogens may be beneficial.

    I should add to say it is a separate disease suggests it could appear without Rosacea and I have never heard of this either.

    In conclusion, Delorians are sweet rides.
    "Get busy living or get busy dying."

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    and

    I agree to the comment about haunting the boards and reading this stuff too much.

    I also agree that a localized and/or generalized swelling isn't rhinophyma. I like your theory of a testosterone connection and I have read that in one article previously. It would explain it's virtual absence in women to some degree.

    That said, I don't know that I concur with the idea that it can't occur without rosacea. I am with you that it is undocumented, and my report- while beyond reproach- is strictly anecdotal. However, being in the construction industry, one is immersed in a subculture of people with little to no regard for their skin, most have no insurance, and there is an abundance of sun damage and hard living. That said, I have run into a few guys who clearly have rhinophyma. Not to the extent of the photo above- but well on their way.

    I have never discussed with any of these guys their condition, history, etc. If it doesn't bother them, why would I bring it up? Further, if it does bother them, why rub their noses in it- pun intended. I have however sat across a 2 wide table for hours on end in mumerous site meetins with some of them and if they have any other sign of rosacea (pick it), I can't find it. I wonder how much sun damage plays a factor as well due it's damging affects on the cells, increase in telangiectasia, etc. Again, not scientific at all but that's the fact jack.

    Anyway, as always, good to have your take.

    Rob
    Last edited by boyandhisdog; 4th April 2009 at 06:11 PM.

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    Senior Member J-Mill's Avatar
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    Default how would that go anyway

    Quote Originally Posted by boyandhisdog View Post
    and
    That said, I don't know that I concur with the idea that it can't occur without rosacea. I am with you that it is undocumented, and my report- while beyond reproach- is strictly anecdotal. However, being in the construction industry, one is immersed in a subculture of people with little to no regard for their skin, most have no insurance, and there is an abundance of sun damage and hard living. That said, I have run into a few guys who clearly have rhinophyma. Not to the extent of the photo above- but well on their way.

    I have never discussed with any of these guys their condition, history, etc. If it doesn't bother them, why would I bring it up? Further, if it does bother them, why rub their noses in it- pun intended. I have however sat across a 2 wide table for hours on end in mumerous site meetins with some of them and if they have any other sign of rosacea (pick it), I can't find it. I wonder how much sun damage plays a factor as well due it's damging affects on the cells, increase in telangiectasia, etc. Again, not scientific at all but that's the fact jack.

    Anyway, as always, good to have your take.

    Rob
    How would that conversation go...

    Rob: Hey Jack do you have a minute.
    Jack: Sure, what's up, you want a beer?
    Rob: No, just wanted to ask you about your nose.
    Jack: What about it?
    Rob: Have you ever heard of Rhinophyma?
    Jack: What the hell are you talking about?
    Rob: Its a disease characterized by the formation or nodules on the nose, it caused by hyperplasia of the sebaceous glands.
    Jack: Are you coming on to me?
    Rob: No, no...just wanted to let you know there is help out there, I mean basic skin care would probably help, what cleanser do you use?
    Jack:
    Rob: Okay, well after work how do you wash the crap off your face.
    Jack: Sometimes the beer backsprays me when I open it.
    Rob: What about the sun, I mean your skin looks like a catcher's mitt, do you use a moisturizing sunscreen?
    Jack: %@#$%@%!!!
    Rob: Never mind.

    Not to overgeneralize.
    Last edited by boyandhisdog; 4th April 2009 at 08:21 PM.
    "Get busy living or get busy dying."

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    You skipped the part where some 50 year old guy that's been working with his hands 10 hours a day, 6 days a week for 30 plus years beats the everloving crap out of me for being a wiseass.

    In my line of work, generally speaking, comments about another man's appearance are definitely frowned upon! Technically, compliments of another man's looks are looked upon even less favorably!

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