The Bard's Blunder-Debunking the Myth Around Rhinophyma.

Abstract

While the eyes are commonly referred to as windows to the soul, studies suggest that the nose could be the door. This most conspicuous facial feature has been shown to influence body image, selfperception, and even personality. The American Society of Plastic Surgeons reports rhinoplasty to be one of the most commonly requested surgical procedures; positive outcomes of these procedures have been shown to ameliorate psychological suffering due to deformities of the nose, to have beneficial psychological implications, and even to allow patients to feel more comfortable with their identity. 1 The role of the nose in shaping one’s image in society is best exemplified through rhinophyma, an end-stage form of rosacea affecting primarily men ages 50 to 70 years, leads to enlargement, fibrosis, and telangiectasia of the nose, and has long been associated with a love of drink. Although alcohol and other substances, such as caffeine, cause local vasodilation that can exacerbate the symptoms, the cause has yet to be elucidated. 2 The common misconception involving alcohol and rhinophyma is illustrated and propagated throughout classical literature. In Macbeth, Shakespeare’s characters warn their readers, “Drink, sir, is a great provoker of three things…nose-painting, sleep, and urine. Lechery, sir, it provokes and unprovokes,” thus mercilessly linking a red nose to alcohol and shameful behavior. The Pardoner in Chaucer’s Canterbury Tales highlights the vices of alcohol through emphasizing its role in disfiguring the face and focuses on the snoring sound of the nose: