Conservative Management of Rhinophyma with Pharmacological Therapy: Experience from a Case Report

Abstract

Rhinophyma represents an advanced manifestation of phymatous rosacea and is characterized by progressive sebaceous gland hyperplasia, dermal fibrosis, and thickening of the nasal skin, resulting in cosmetic deformity and, in advanced cases, functional impairment. Although surgical intervention remains the standard treatment for moderate to severe rhinophyma, conservative medical management may represent a therapeutic option for carefully selected patients with early stage disease. We report the case of a 49-year-old man with a long-standing history of rosacea who presented with progressive nasal enlargement, persistent erythema, and cutaneous hypertrophy consistent with early rhinophyma. Clinical examination revealed no ulceration, rapid focal growth, atypical pigmentation, or other findings raising clinical suspicion of malignancy, and there was no evidence of functional airway compromise. Conservative treatment was initiated with oral isotretinoin at a dose of 20 mg/day, combined with topical metronidazole, strict photoprotection, and avoidance of identified triggering factors. The patient was followed regularly for six months, during which progressive reductions in erythema, sebaceous activity, and clinically apparent phymatous tissue were observed, accompanied by improvement in nasal contour and skin texture. Liver function tests and lipid profiles remained within reference ranges, and treatment was well tolerated throughout the follow up period. Given the clinical improvement observed during treatment, surgical intervention was not pursued. This case suggests that pharmacological management may be considered in selected patients with early rhinophyma, particularly before marked fibrotic and structural changes develop. However, conclusions regarding treatment efficacy cannot be established from a single case, and prospective studies are required to better define patient selection criteria, standardized treatment protocols, and long-term outcomes.