Stage Of Rosacea Research Articles

Lipid-Laden Floret-Like Multinucleated Giant Cells: A Novel Histopathologic Observation in Rhinophyma.

Rhinophyma is the advanced stage of rosacea and manifests clinically with disfigurement of the nose. The histopathology has been classified into classical and severe types. We studied the clinicopathological characteristics of 8 cases with the diagnosis of rhinophyma. In 5 of 9 specimens, floret-like multinucleated giant cells containing lipid were identified. This finding, to the best of our knowledge, has not been previously described.

The Surgical Treatment of Rhinophyma–a Case Report

Background: Rhinophyma represents an advanced stage of rosacea, chronic cutaneous inflammatory disorder of the pilosebaceous unit with unknown etiology and primarily affects the central face, predominantly the nose region. Significant psychosocial effects are associated with the disease. The diagnosis is made according to the physical exam and pathohistological findings. Rhinophyma occurs more often in middle aged and older male patients. Objective: The aim of this article was to present the cause of rhinophyma, clinical characteristics, surgical treatment and postoperative results. Case report: We present the case of a 60-year-old male patient with rhinophyma, who was successfully treated surgically at the Clinic of Plastic and Reconstructive Surgery. Conclusion: There is no gold standard treatment for rhinophyma. However, surgical treatments, such as scalpel excision, dermabrasion, cryosurgery, argon laser, carbon dioxide laser, and electrocautery, have been used.

Ultrasonic diagnostics of vascular complications after laser procedures

A clinical case of treatment of rosacea with a high-intensity laser at different stages, performed under control of high-resolution ultrasound (HRU), is presented. According to clinical guidelines, patients in the erythematous stage of rosacea (stage I) undergo selective coagulation of superficial vessels with a neodymium laser. Diagnosis and determination of the severity of the disease are carried out based on the presence of primary and secondary elements of the rash. There are no criteria for ultrasound assessment of the skin and its vascularization in patients with rosacea. During ultrasound examination after 4 laser procedures in B-mode, the dermis is heterogeneous due to hypoechoic papillary and hyperechoic reticular layers, without signs of infiltrative changes, in the color Doppler mapping mode there is a pronounced vascularization of the papillary dermis in the area of interest, represented by multiple vessels in contrast to single vascular structures seen on ultrasound after two laser treatments. According to the results of ultrasound examination, a more severe degree of the disease was diagnosed, which served as the basis for prescribing therapy with systemic retinoids. Clinical observation demonstrates the capabilities of ultrasound in planning laser procedures in order to reduce the risk of complications, their early diagnosis and monitoring of treatment if they occur.

A systematic review and current recommendation for treatment ofrhinophyma

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.

Rhinophyma: Prevalence, Severity, Impact and Management.

Rhinophyma is an advanced stage of rosacea affecting the nasal soft tissues and resulting in disruption of the nasal architecture, airway obstruction, and disfigurement of the nasal aesthetic units. Rhinophyma presents with hypertrophy of the nasal soft tissues, erythema, telangiectasias, nodules, and lobules with a bulbous appearance. Significant psychosocial morbidity is associated with the disease. Understanding of this disease has improved and multiple treatment options exist. The article is a review of the literature to evaluate the pathophysiology, clinical presentation, and epidemiology of keywords “rhinophyma” and “rosacea” using an OVID Medline and PubMed search along with a systematic review of outcomes pertaining to treatment of rhinophyma with laser therapy, scalpel excision, and the subunit method using an OVID Medline search. The subunit method has the highest complication and revision rates followed by carbon dioxide laser therapy. Outcomes between carbon dioxide laser and scalpel therapy and electrocautery are equivalent. Scalpel excision is a more cost-effective treatment modality with less post-operative complications; however, it risks poor hemostasis intraoperatively. Patient satisfaction is common post-therapy regardless of the treatment method. Over 89% of patients would recommend undergoing treatment for rhinophyma irrespective of treatment type. Treatment options vary, and choice of treatment can be dependent on practitioner and patients’ treatment goals.

Treatment of rhinophyma using a copper vapor laser

Background. Rhinophyma is considered to be the most severe stage of rosacea, associated with the proliferation of the nose skin epithelium, hyperproduction of the sebaceous glands and telangiectasia.The treatment of rhinophyma remains a difficult task. One of the problems associated with rhinophyma is thickened and lumpy skin, penetrated with telangiectasias. The use of laser radiation in the treatment of rhinophyma seems to be promising, since this method allows blood vessels to be selectively heated.For the first time, we describe the treatment of rhinophyma using a copper vapour laser (CVL) equipped with a computerized scanner.Patient description. A 63-year-old male with Fitzpatrick skin type II was treated using an CVL (‘Yakhroma-med' model, RaS P. N. Lebedev Physical Institute). The clinical manifestations of the disease were typical of the phymatous or hypertrophic rhinophyma type, including significant thickening of the tissues and an uneven roughness of the skin surface. The treatment was carried out using a radiation wavelength of 578 nm, exposure duration of 0.2 s and energy exposure (fluence) of 15-30 J/cm2. Operational parameters used for the CVL in the scanner mode were the average power of 0.6-1.2 W and the focusing size of the light spot on the skin of 0.6 mm. The hexagonal mode of the scanning head was used with a maximum size of 12 mm and 1 mm distance between the centres of the laser spots. The treatment resulted in the restoration of the natural nose shape without redness. No side effects were noted.Conclusion: CVL radiation provided a selective photodisruption of the vessels with increased diameter.Due to the remodelling of the vasculature, the described method showed excellent results in the treatment of rhinophyma without side effects.

Rhinophyma and Gnathophyma Concomitantly in a 54-Year-Old Female a Clinical-Histopathology Correlation and Review of the Literature

Rhinophyma (Greek “nose growth”) is a benign dermatologic disease of the nose [1]. It is characterized by a slowly progressive enlargement of the nasal skin, with irregular thickening and nodular deformation leading to an erythematous appearing nose. Phyma is the last stage of rosacea and is due to chronic inflammation and edema. Although the great majority of phymatous lesions occur on the nose (rhinophyma), they may also occur at other sites. It affects mostly men. Even though the exact cause of rhinophyma is unknown, it is believed to be multifactorial in origin with a principal etiology of unregulated superficial vasodilation. The main reasons that urge the patients to seek help are functional and cosmetic impairments, such as nasal obstruction or disfigurement. Surgical removal of the hyperplastic tumor mass is the treatment of choice for rhinophyma. The aim of the article is to present an update on the pathophysiology, clinical features and treatment of rhinophyma and gnathophyma in a 54-year-old female patient.

Rhinophyma: Our experience based on a series of 12 cases

IntroductionRhinophyma is a rare, benign and unsightly disease of the skin of the nose that was first described a very long time ago, as illustrated by portrait of an old man with a bulbous nose holding his grandson, by Ghirlandaio in 1490. It was described for the first time by Ferdinando Hebra Von (1816–1880), as the third stage of rosacea. The objective of this study is to report the author's experience and propose a new treatment option in the management of rhinophyma. Material and methodsWe describe our experience of rhinophyma based on a retrospective case study. ResultsWe identified 12 cases over a 12-year period, with a marked male predominance. The therapeutic approach was the same in all patients, consisting of a combination of dermabrasion, decortication and application of fibrin glue, with a favourable outcome in every case with complete epithelialisation. ConclusionRhinophyma is a rare condition of uncertain pathophysiology. Management is surgical and, in view of the many techniques and procedures proposed, we advocate the slogan “to each his own technique”, until a consensus has been reached. Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results.

A rare combination of inverse acne and infiltrative-productive stage of rosacea

The analysis of literature and exceptional clinical case of combination of inverse acne and infiltrative-productive stage of rosacea are presented. The historical facts, ethiopathogenesis, comorbidity, treatment, clinical picture and diagnostics with use of both standard and invasive methods of research (histological method) are described. Successful treatment of combination of inverse acne and an infiltrative-productive stage of rosacea with antibiotics and actinolyzat is reported.

Basal Cell Carcinoma Masked in Rhinophyma

Rhinophyma, the advanced stage of rosacea, is a lesion characterized by progressive hypertrophy and hyperplasia of sebaceous glandular tissue, connective tissue, and blood vessels. Rhinophyma can lead to a significant facial disfigurement and severe emotional distress, but it is not only an aesthetic problem, since rare cases of simultaneous presence of malignant tissue are described in the literature. The case of an 84-year-old farmer affected by basal cell carcinoma (BCC) and diagnosed in the context of rhinophyma is presented. The anatomical distortion produced by the chronic inflammation and fibrous scarring makes the BCC diagnosis difficult and uncertain. The histological examination of the entire mass and its margins is fundamental. A partial biopsy can lead to a false negative result, and the histological examination must be repeated intra- or postoperatively.

Gnatophyma: a rare form of rosacea

Phyma is the last stage of rosacea and is due to chronic inflammation and edema. It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location and there are few reports about gnatophyma. We report the case of a female patient, 41 years old, who had an infiltrated, erythematous, edematous plaque around the chin and lower lip for two years. Histopathology showed perivascular lymphocytic infiltrate, hypertrophied follicles and sebaceous glands, dilated vessels and fibrosis. She was treated with oral tetracycline, oral ivermectin and metronidazole cream with a satisfactory response. The clinical, histopathological and therapeutic response correlation confirmed the diagnosis of gnatophyma, a rare variant of phyma.

Isotretinoine in the treatment of rosacea

Goal: Evaluation of isotretinoine acnecutane) in small doses (0,2 mg/kg/day) in the treatment of papulopustular stage of rosacea. Маterials and methods. 21 patients with papulopustular version of rosacea, not responding to traditional therapeutic methods have been examined. Patients were receiving small doses of isotretinoine acnecutane) (0,2 mg/kg/day). The efficiency of the performed therapy was evaluated with the dermatologic index of life quality. Results. The research has demonstrated the high efficiency of isotretinoine acnecutane) in the treatment of papulopustular stage of rosacea. The use of small doses of the substance allowed to minimize side effects, which can take place at the background of isotretinoine (acnecutane), providing the high safety of it’s application.

Evaluation of surgical treatment of rhinophyma with tangential shear of the lesion

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Witmanowski H, Lewandowicz E, Sobieszek D, Łuczkowska M, Rykała J. Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2012;29(6):411-416. doi:10.5114/pdia.2012.32387. APA Witmanowski, H., Lewandowicz, E., Sobieszek, D., Łuczkowska, M., & Rykała, J. (2012). Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 29(6), 411-416. https://doi.org/10.5114/pdia.2012.32387 Chicago Witmanowski, Henryk, Edward Lewandowicz, Daria Sobieszek, Magdalena Łuczkowska, and Jan Rykała. 2012. "Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 29 (6): 411-416. doi:10.5114/pdia.2012.32387. Harvard Witmanowski, H., Lewandowicz, E., Sobieszek, D., Łuczkowska, M., and Rykała, J. (2012). Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 29(6), pp.411-416. https://doi.org/10.5114/pdia.2012.32387 MLA Witmanowski, Henryk et al. "Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 29, no. 6, 2012, pp. 411-416. doi:10.5114/pdia.2012.32387. Vancouver Witmanowski H, Lewandowicz E, Sobieszek D, Łuczkowska M, Rykała J. Original paperEvaluation of surgical treatment of rhinophyma with tangential shear of the lesion. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2012;29(6):411-416. doi:10.5114/pdia.2012.32387.

Rhinophyma et carcinomes cutanés associés : à propos d’un cas et revue de la littérature

Rhinophyma, final stage of rosacea is considered as benign pathology. We present the case of a patient with basal cell carcinoma diagnosed on rhinophyma. The removal of all cutaneous nasal unit and its analysis has diagnosed the presence of three basal cell carcinomas and two in situ squamous cell carcinomas. Reconstruction was performed by full-thickness skin graft. The literature reports a few cases of association between rhinophyma and skin cancers but none ever reported the simultaneous presence of basal cell carcinoma and squamous cell carcinomas. The low number of articles does not reveal statistically significant relationship between rhinophyma and skin cancer, which would consider the rhinophyma as a risk factor. Monitoring of these patients should be as rigorous as possible and surgical care requires histologic analysis not to omit the presence of cancerous lesions.

Malignancies Within Rhinophyma: Report of Three New Cases and Review of the Literature

Rhinophyma, which represents the end stage of rosacea, is characterized by sebaceous hyperplasia, fibrosis follicular plugging, and telangiectasia. Although it is commonly labeled as an aesthetic problem, it may also determine airway obstruction and because of its nature to hide the growth of tumors. Due to the increasing number of reports of nonmelanoma skin types of cancer within rhinophyma, further concern about a higher incidence of malignancies in rhinophyma than in the skin of normal noses is reasonable. We describe three male patients who developed malignancies (2 basal and 1 squamous cell carcinoma) associated with rhinophyma disease. The tumors developed over a mean of 23.3 years after primary diagnosis of rhinophyma. One case had a previous history of facial skin tumor. Surgical excision with clear margins allowed resolution in all three patients with a mean follow-up of 34.8 months. These three new cases and the review of 43 cases reported in the literature call attention to the clinical features of carcinomas arising in the context of rhinophyma, raising further concerns about the possible association between these two entities. The need for histologic examination of all surgically removed tissue in patients with rhinophyma is highlighted. Several macroscopic changes, including ulceration, drainage, and a rapid growth pattern, should alarm the physician and should be considered as suspicious of a malignant degeneration. Unexpected clinical modifications of a preexisting long-lasting silent rhinophyma could indicate the possibility of hidden malignancy rather than a rhinophyma itself. Although evidence of an association between the two entities remains inconclusive, half of the malignancies reported in our review were incidental findings associated with rhinophyma. Thus, since rhinophyma should not be considered solely a cosmetic problem, we recommend that all specimens be reviewed by a pathologist and if malignancy is diagnosed, re-excision with clear margins should be achieved when necessary with periodic follow-up.

Gnatophyma and Otophyma

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea. The most common phyma is rhinophyma, yet similar swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Unlike rhinophyma, otophyma is rarely seen. We report two rare phymas: a case of gnatophyma and a case of otophyma. A 56-year-old African American man presented with a history of bumps on his chin that had begun about 7 years earlier. Physical examination was remarkable for lobulated plaques on the chin, coalescing into hypertrophic nodules and dilated pores. A 73-year-old African American male presented with bilateral cauliflower-like earlobe growths for the past 17 years. A skin biopsy was performed for each patient demonstrating cystic follicular dilatation with keratin plugging, dermal scarring, psoriasiform epidermal hyperplasia, and chronic inflammation of some of the follicles. This case report describes a relatively rare gnatophyma and otophyma. Surgical management is well accepted as the best mode of therapy to treat rhinophyma and is becoming a first-line treatment for all phymas.

Otophyma: a rare and frequently misdiagnosed entity

Otophyma is the term used for sebaceous gland hypertrophy and hyperplasia of the ear. It is usually the end stage of rosacea—a common, chronic, cutaneous disorder of unknown etiology. We hereby present a rare case of otophyma with its clinical features, its etiology, diagnosis, and review of medical and surgical therapy. This patient remained undiagnosed and mismanaged for many years before she was finally diagnosed with this rare condition and successfully managed by surgical technique. To our knowledge, this is the second case of otophyma presented in the otolaryngological literature.

Gnatophyma: a rare variant of phyma

We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.

New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal.

Rhinophyma is considered to be the final stage of rosacea and has an unknown aetiology. We present two new surgical adjuncts for the treatment of this condition. The microdebrider is easy to use and allows precise contouring of the nose. It shares the same underlying principle as free-hand scalpel shaving but outperforms this method in key areas. We also describe a novel use for FloSeal((R)), a gelatin-thrombin co-mixture, utilizing its haemostatic properties to address bleeding from the re-shaped denuded nose.

A12. IPL therapy in the inflammatory stage of rosacea

The inflammatory stage of Rosacea iscommonly treated with topical or oral antibiotics. However, if additional erythema and telangiectasias are present, antibiotics are not successful. IPL (intense pulsed light) is mostly involved when only initial or residual telangiectasias are present. Application of IPL simultaneously with topical or oral medicine could be an effective form of treatment in the inflammatory stage of rosacea. This study was performed in order to detect the effect of IPL application with simultaneous topical antibiotics in inflammatory rosacea and to assess the efficacy of IPL therapy in routine treatment of rosacea.Twenty patients aged between 34 and 70 with papulopustular rosacea (14 female and 7 male) were included in the study. Ten patients (group I) were treated for 21 weeks with topical metronidazole. The other ten patients (group II) received an additional 3 sessions with IPL 515–755 nm Photoderm VL technology over 4 weeks. Treatment affectivity was recorded by digital visualisation and patient satisfaction scale before each IPL session.In all patients, significant reductions in papulopustular elements were observed. Eight out of 10 patients (group I) still showed permanent erythema and telangiectasias despite topical treatment. In 3/10 patients a few telangiectasias remained following the treatment in contrast to 5/10 satisfied group I patients. The most effective treatment was the application of 570 nm and 590 nm wavelength at a fluence of 25–55 J/cm2.Application of IPL in inflammatory rosacea is equally as safe and effective in residual or initial lesions. Moreover, in combination with antibiotics, it promotes reduction of all symptoms, is less time‐consuming and is more successful for patients. The pathogenetic influence of IPL in rosacea seems not only to be limited to selective photothermolysis of dilated blood vessels, but may also have immunomodulatory effects on inflammatory processes and possibly on collagen remodelling. The combination of IPL and antibiotics from theoutset of rosacea therapy is considered to be highly effective.