Vestibulophyma and Giant Rhinophyma Associated With Variant Rosacea

Abstract

In July 2013, a 44-year-old Taiwanese man was admitted to Kaohsiung Chung-Ho Memorial Hospital, presenting with a 3-year history of progressively growing nasal mass with pustules and foul smelling discharge. He is a victim of cerebrovascular accident 4 years ago, hypertension for 12 years, and left hemiplegia. He has no personal history of smoking or alcoholism. Facial disfigurement led to psychological distress, and he sought out residence at a nursing home as a social recluse. Examination revealed a giant pedunculated bulbar mass measuring 23 × 13 × 8 cm and extending from the forehead to over the tip of the nose, with complete obliteration of the normal nasal contour. MRI scan revealed extensive nasal cutaneous lobulated tumors with complete obstruction of his left nostril due to vestibular phymatous lesions. Following biopsy results, we diagnosed the patient with “vestibulophyma”, giant rhinophyma with extensive external phymatous lesions, and concomitant presentation of all four rosacea subtypes. After undergoing application of topical metranidazole jelly and low oral dose of doxycycline (40 mg/day) for 2 weeks, we proceeded with surgical intervention of giant rhinophyma de-bulking, vestibulophyma resection, inferior turbinectomy, and middle turbinectomy with microdebrider. Full thickness skin graft played an important role as an ideal and effective biological dressing during the healing process. The patient is currently well and satisfied with the results. J Med Cases. 2015;6(5):216-218 doi: http://dx.doi.org/10.14740/jmc2121w