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Case Reports
Electrosurgery in the treatment of giant
rhinophyma: a case report
Eletrocirurgia no tratamento de rinofima gigante : relato de um
caso
Authors:
Thaís Abrão Cardoso1
Jeane Jeong Hoon Yang1
Ed Wilson Tsuneo Rossoe2
Dermatology Specialist Candidate, Complexo Hospitalar Padre Bento de Guarulhos (CHPBG) - Guarulhos (SP), Brazil.
1
2
Plastic Surgeon. MSc in Health Sciences by
the Hospital do Servidor Público Estadual
(HSPE). Preceptor, Medical Residency Program in Dermatology, CHPBG -Guarulhos
(SP), Brazil.
Correspondence:
Correspondência para:
Dra. Thaís Abrão Cardoso
Rua Dona Margarida Galvão, 177/111
07051030 - Guarulhos - SP - Brasil
E-mail: [email protected]
Received on: 22 November 2014
Approved on: 14 September 2015
*This study was carried out at Complexo Hospitalar Padre Bento de Guarulhos (CHPBG) Guarulhos (SP), Brazil.
Financial support: None.
Conflict of interest: None.
Surg Cosmet Dermatol 2015;7(3 Suppl 1):S50-2.
DOI: http://dx.doi.org/10.5935/scd1984-8773.2015731567
ABSTRACT
Rhinophyma is characterized by the hyperplasia of sebaceous glands in the nasal region, associated with a nodular thickening of the skin, enlargement of the pores, and
fibrosis in the later stages. It occurs most commonly in male patients bearing rosacea,
and may be associated with phymas in the region of the mentum (gnatophyma), ears
(otophyma) and forehead (metophyma). The present article describes a case of giant
rhinophyma with significant impact on the patient’s quality of life, hampering breathing, sleeping, and eating. The lesion was successfully treated with electrosurgery.
Keywords: electrosurgery; rhinophyma; dermatologic surgical procedures
RESU­MO
O rinofima é caracterizado por hiperplasia das glândulas sebáceas da região nasal, associada
a espessamento nodular da pele, dilatação dos poros e fibrose nos estádios tardios. Ocorre mais
comumente em homens portadores de rosácea, e pode estar associado a fimas na região do mento
(gnatofima), das orelhas (otofima) e da fronte (metofima). Apresenta-se um caso de rinofima
gigante com repercussão importante na qualidade de vida do paciente, dificultando a respiração, o
sono e a alimentação. A lesão foi tratada por eletrocirurgia com sucesso.
Palavras-chave: eletrocirurgia; rinofima; procedimentos cirúrgicos dermatológicos
Introduction
Rosacea is a common condition in adults and is characterized by a variety of clinical manifestations. Its pathogenesis is
multifactorial, nevertheless it is clearly related to vascular hyperactivity.1, 2 Rhinophyma is a late manifestation stage of rosacea
and presents with hyperplasia of the sebaceous glands and the
connective tissue of the nasal region in its progressive pathophysiology.3 It is possible to clinically observe swelling and subsequent
lobulation, dilation of the pores, and unevenness in the surface of
the nose, which may also increase in size over time. Patients with
large-dimension rhinophyma can present with nasal obstruction
accompanied by respiratory distress and feeding difficulty, as well
as a disfiguring appearance and social isolation.1, 4
There are different treatment modalities described in the
literature, such as electrosurgery, carbon dioxide laser, cryosurgery and dermabrasion. There is no consensus in the literature
regarding the best technique, and all have advantages and disadvantages.4, 5
Electrosurgery in rhinophyma 51
Case report
A 60-year-old male patient with a history of progressive
modification of the nasal contour over the previous 10 years and
with a worsening of the condition during the last three years and
a significant enlargement of the nose. (Figure 1)
Electrosurgery was chosen as a therapy to approach the
lesion. After asepsis and antisepsis were carried out with povidone-iodine, a bilateral anesthetic block was performed in the
infraorbital nerve, with additional injection in the surface of the
nasal skin.
The procedure was performed with a monopolar electrocautery (model SS500, Wem Equipamentos Eletrônicos®,
Rio de Janeiro, Brazil), set at Cut Blend 1 mode, 2W potency,
using the small round handle tip (0.3 mm thick and 1.2 cm in
diameter). Due to profuse bleeding that occurred during the
first surgery, two similar surgical steps were necessary at intervals
of three months. An occlusive dressing with an ointment containing 0.6U/g collagenase and 0.01g/g chloramphenicol was
applied, with daily changes for ten days. The total epithelization
of the surface of the nose took place over 15 days.
The result was very satisfactory from an aesthetic and
functional point of view (Figure 2), and the patient had a significant improvement in his quality of life.
DISCUSSION
Rhinophyma is a part of late-stage rosacea. The invasive
approach to treatment – either by conventional surgery, electrosurgery, carbon dioxide laser, or cryosurgery--is mandatory in
the treatment and cure of the lesion.5, 6
Figure 1: Giant rhinophyma: the presence of phymatous tissue can also be noticed in the malar region, in addition to nasal and oral obstruction
Figure 2: Seven months after surgery
Surg Cosmet Dermatol 2015;7(3 Suppl 1):S50-2.
52
Cardoso TA, Yang JJH, Rossoe EWT
Giant rhinophyma is not a common presentation, but is
one that causes significant impact on a patient’s quality of life,
interfering with vital functions such as breathing and eating. A
compromise of self-esteem and the entailed social isolation can
also occur due to the grotesque appearance that it causes, or due
to the myth of association with alcoholism.6 There is no consensus in the literature regarding the best therapeutic approach
to rhinophyma.4, 5 Any therapeutic technique adopted should
preserve the normal tissue, sparing the hair follicles of the dermis
underlying the lesion, in order that reepithelialization can start
with these follicles, lessening the risk of unsightly scars.4
In the present case, electrosurgery has proved to be a safe,
effective, fast, and low cost therapeutic modality.
In addition to providing a satisfactory cosmetic result, the
patient experienced a relief of respiratory distress in the immediate post-operative period. In addition to functional improvement, there was also a significant improvement in the patient’s
self-esteem and hence social life.l l
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Seiverling EV, Neuhaus IM. Nare obstruction due to massive rhinophyma treated using the Shaw scalpel. Dermatol Surg. 2011;37(6):876-9.
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Webster GF. Rosácea e alterações relacionadas. In: Bolognia JL,Jorizzo
JL,Rapini RP. Dermatologia. Rio De Janeiro: Elsevier ; 2011.
Lazzeri D, Agostini T, Spinelli G. Optimizing Cosmesis with Conservative Surgical Excision in a Giant Rhinophyma. Aesth Plast Surg. 2013;
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