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  • Your dermatology provider prescribes your formula

  • Apply nightly for happy, healthy skin

Everything you need to know about rhinophyma, a severe symptom of rosacea

Just because you have rosacea on your nose doesn’t mean you’re dealing with this condition.

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Curology Team
Oct 18, 2022 · 6 min read

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We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.
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No one signs up for rosacea. Yet, it affects more than 16 million Americans.¹ And no one wants it to progress to rhinophyma—a skin condition that causes the skin on the nose to appear thick, enlarged, and swollen.

Rhinophyma can happen in severe, advanced cases of rosacea, and it needs to be diagnosed by an in-person dermatology provider. It’s not something we can treat at Curology, but we’re here to share what we know. 

That said, it’s important to understand that rosacea only on the nose is rather rare, and having a swollen nose or thicker skin on the tip of your nose isn’t always rhinophyma. Usually, rosacea appears on the central face, and in some cases, it can affect your ears, chest, and neck. Currently, there’s no cure for rosacea, but here we’ll share how rosacea is diagnosed in general and how it’s treated. Spoiler alert: Early treatment is key!

Diagnosing rosacea 

Rhinophyma is a symptom of advanced rosacea, not a stand-alone condition. That means before you develop rhinophyma, you’ll likely experience more common symptoms of rosacea. These often include persistent redness or facial flushing or blushing. Symptoms, which occur in cycles called flare-ups, can be triggered by things like hot beverages, spicy foods, and sun exposure. Everyone’s triggers are different, and if you have rosacea, knowing yours is a big part of managing it and preventing its progression.

What the main cause of rosacea remains largely unknown. However, science believes there’s a link to genetics, immune system dysfunction, Demodex mites (sounds gross, we know), and an intestinal bug (H pylori).²

Dermatologists use the National Rosacea Society’s standard classification system and diagnosis guidelines for rosacea. Diagnosis is based on the appearance of at least one diagnostic or two major phenotypes.³ 

Diagnostic features include:

  • The persistent facial redness in a characteristic pattern

  • Phymatous changes

Major features include: 

  • Flushing 

  • Papules and pustules 

  • Telangiectasias (visible blood vessels) 

  • Eye involvement 

Is it or isn’t it rhinophyma?

Symptoms of rosacea on the nose are not always rhinophyma. Rosacea can result in rhinophyma, but again, it’s rare. Even when people experience mild rosacea symptoms on the nose, it does not mean it will progress to rhinophyma. 

Rosacea is most common in middle-aged white women. It can result in blushing or persistent erythema (redness) of the face but can also include acne-like lesions (papules and pustules). Mild rosacea symptoms come and go during periods called “flare-ups”. They often appear in a symmetrical pattern across the nose, cheeks, chin, and forehead.⁴ Rosacea is often mistaken for acne, but rosacea and acne are two different conditions. 

Rhinophyma is most common in men over the age of 50.⁵ It causes the nose to appear bulbous, enlarged, and lumpy, and the surrounding skin becomes thickened.

Signs of severe rosacea 

The exact cause of rhinophyma is unclear, but research shows that blood vessel dilation can lead to fluid leakage underneath the skin, resulting in inflammation and hardening of the skin, also called fibrosis. Enlarged (hypertrophic) sebaceous glands and a thickened underlying skin layer can develop. If left untreated, rhinophyma can cause respiratory issues, making breathing difficult. Because rhinophyma mostly occurs in males, some suggest that higher androgen hormones may play a role.⁶

But just because phymatous changes like those associated with rhinophyma can occur doesn’t mean they will. Early treatment for rosacea is your best defense at warding off unwanted skin thickening. That’s why it’s so important to know the signs of phymatous changes on the nose.

Signs of phymatous changes on the nose

Like most skin conditions, early treatment is your best prevention. That comes with knowing what to watch for. Phymatous changes on the nose progress over time—it’s not an overnight phenomenon. Here are signs of phymatous changes (thickening skin) due to rosacea: 

  • Bumpy skin texture

  • Thickened skin (most commonly around the nose)

  • Larger pores

  • Visible broken or dilated blood vessels

  • Skin that’s oilier than usual

nose with rosacea condition on it

Seek timely treatment

Most people want to know how to get rid of rosacea permanently. Unfortunately, there’s no cure—yet. But getting timely rosacea treatment can help prevent flare-ups and the progression of this chronic condition. Treatment includes identifying your triggers, which might include hot drinks, spicy foods, red wine, and other alcoholic beverages, environmental factors, sun exposure, emotional stress, and others.⁷ 

Dermatology providers can also provide skincare tips and prescribe topical medications, including metronidazole, azelaic acid, and ivermectin, to treat papules, pustules, inflammation, and persistent redness. And, it almost goes without saying, it’s important to wear sunscreen with at least SPF 30 and opt for rosacea-friendly makeup.

Remember, rhinophyma is benign at first, meaning it’s not harmful. But as it progresses, it can block nasal airways, causing difficulty breathing. That’s why it’s critical to see a dermatology provider and seek professional advice early. Surgery is almost always required for advanced symptoms. 

How to treat rhinophyma 

Rosacea nose treatment for advanced rhinophyma requires surgery to remove the thickened tissue. Surgical shaving is an invasive procedure that often requires a full-thickness skin graft following the removal of the phymatous skin, but even after removing the thickened skin, there’s no guarantee it won’t happen again.⁸ Other techniques include dermabrasion followed by dermaplaning, debulking with medical scissors, electrocautery, and laser treatment therapies.⁹ 

Curology can help you treat symptoms of rosacea 

At Curology, we currently focus on diagnosing and treatments acne, rosacea, and anti-aging concerns. While we don’t treat rhinophyma, we can share the info to help you know what to look for so you can seek in-person dermatology care as early as possible. 

If you’re experiencing symptoms of rosacea, Curology members receive a personalized prescription formula prescribed by a licensed dermatology provider with ingredients like ivermectin, metronidazole, and azelaic acid, depending on what treatment your provider thinks may be best for your skin goals. Signing up is easy. Just take a short quiz and snap a few selfies. Our dermatology team will evaluate your skin, and if Curology is right for you, we’ll pair you with one of our licensed dermatology providers.

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FAQs

Is it or isn’t it rhinophyma?

Symptoms of rosacea on the nose are not always rhinophyma. Rosacea can result in rhinophyma, but again, it’s rare. Even when people experience mild rosacea symptoms on the nose, it does not mean it will progress to rhinophyma. 

What are the signs of phymatous changes on the nose?

Phymatous changes on the nose progress over time—it’s not an overnight phenomenon. Here are signs of phymatous changes (thickening skin) due to rosacea: 

  • Bumpy skin texture

  • Thickened skin (most commonly around the nose)

  • Larger pores

  • Visible broken or dilated blood vessels

  • Skin that’s oilier than usual

How to treat rhinophyma?

Rosacea nose treatment for advanced rhinophyma requires surgery to remove the thickened tissue. Surgical shaving is an invasive procedure that often requires a full-thickness skin graft following the removal of the phymatous skin, but even after removing the thickened skin, there’s no guarantee it won’t happen again.

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P.S. We did the homework so you don’t have to:

  1. American Academy of Dermatology. Skin conditions by the numbers. (n.d.).

  2. American Academ of Dermatology. Rosacea: Who gets and causes. (n.d.).

  3. Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. (2018).

  4. Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Ibid.

  5. Dick, M.K., et al. Rhinophyma. StatPearls. (2022, May 24).

  6. Dick, M.K., et al. Rhinophyma. StatPearls. Ibid.

  7. National Rosacea Society. Factors that may trigger rosacea flare-ups. (n.d.)

  8. Gupta M., et al. Severe rhinophyma treated by shave excision and electrocautery.BMJ Case Reports. (2020, January 13).

  9. Chang, D. K., et al. A Safe, Modern Treatment of Rhinophyma: The 5-Step Technique. Plastic and reconstructive surgery. (2020).

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Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
Curology Team Avatar

Curology Team

Kristen Jokela, NP-C

Kristen Jokela, NP-C

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