Yim Chelsea, Chon Jeewon, Laub Peter, Ogrodnik Joseph
Department of Plastic and Reconstructive Surgery, Loyola University Medical Center, Chicago, USA.
Cureus. 2025 Apr 13;17(4):e82207. doi: 10.7759/cureus.82207. eCollection 2025 Apr.
Rhinophyma is a progressive dermatologic condition of the nose that is characterized by hypertrophic thickening of the skin, edema of the nasal pyramid, and hyperplasia of nasal sebaceous glands and connective tissue. We present a case of severe rhinophyma, where the patient delayed seeking treatment due to social isolation during COVID-19 and apprehension about surgery. Mask-wearing concealed the deformity and allowed it to worsen. We will demonstrate the surgical technique with a photo timeline, illustrating healing progression. This is a useful adjunct when counseling patients with rhinophyma on the expected post-operative course and appearance. A 67-year-old male patient presents with enlarging cysts and thickening epidermis on the nose resulting in large hypertrophic, nodular lesions and telangiectasias. His nose was deformed with multiple pedunculated lesions from the nasal dorsum, sidewalls, and along the alar rims. The largest lesion measured 5 cm; six were excised using electrocautery. Each sebaceous cyst was excised individually to create a more uniform surface. The remaining skin had severe rhinophyma. Loop electrocautery (LP) was used to excise the nasal dorsum and bilateral nasal sidewalls, the alar rims over the soft tissue triangle, and the nasal tip and over the columella. A 5-mm tip was used for finer elements, producing an improved nasal shape, and no cartilage was exposed. The nose was dressed with antibiotic ointment and nonadherent gauze with absorptive gauze overlay. Several serial photos will demonstrate rapid healing. The patient's nose was fully epithelized one month post-operatively with much-improved contour and shape. Primary excision of nodular cystic lesions followed by LP can help restore normal nasal appearance in patients with deforming rhinophyma. Healing via secondary intention with daily dressing changes remains an excellent strategy for patients' status post rhinophyma excision. The photo timeline of this severe rhinophyma case is a valuable tool when counseling future patients who are apprehensive about undergoing surgical intervention.
鼻赘是一种鼻子的进行性皮肤病，其特征为皮肤肥厚性增厚、鼻锥体水肿以及鼻皮脂腺和结缔组织增生。我们报告一例严重鼻赘病例，该患者在新冠疫情期间因社交隔离以及对手术的担忧而延迟就医。佩戴口罩掩盖了畸形，使其病情恶化。我们将通过照片时间线展示手术技术，说明愈合过程。这在向鼻赘患者咨询术后预期病程和外观时是一种有用的辅助工具。一名67岁男性患者，鼻子上出现囊肿增大和表皮增厚，导致巨大的肥厚性结节性病变和毛细血管扩张。他的鼻子因鼻背侧、侧壁以及鼻翼边缘出现多个带蒂病变而变形。最大的病变直径为5厘米；使用电灼术切除了6个病变。每个皮脂腺囊肿都单独切除，以形成更均匀的表面。剩余皮肤有严重鼻赘。使用环形电灼术（LP）切除鼻背侧和双侧鼻侧壁、软组织三角上方的鼻翼边缘、鼻尖以及鼻小柱上方。使用5毫米的电极头处理更精细的部位，改善了鼻子形状，且未暴露软骨。鼻子用抗生素软膏和不粘纱布覆盖，并叠加吸收性纱布包扎。一系列连续照片将展示快速愈合过程。术后一个月，患者的鼻子完全上皮化，轮廓和形状有了很大改善。对于有变形鼻赘的患者，先切除结节性囊性病变再进行LP手术有助于恢复正常鼻外观。通过二期愈合并每日更换敷料，仍然是鼻赘切除术后患者的一种极佳治疗策略。这个严重鼻赘病例的照片时间线是向未来担心接受手术干预的患者咨询时的一个有价值的工具。
