Abstract:

Rhinophyma and angiofibromas are both benign skin lesions of the central face with typically distinct clinical presentations. Rhinophyma, a progressive irregular bulbous enlargement of the nose usually presents in the setting of chronic severe rosacea. Classically, rhinophyma demonstrates overgrowth of sebaceous glands, dilated infundibula with keratin retention, telangiectasia, and fibrosis. A fibrous variant of rhinophyma (FVR) is rarely described which clinically resembles rhinophyma but histologically mimics angiofibroma with loss of sebaceous and adnexal structures with prominent fibrosis and an edematous myxoid stroma. Little has been reported on this entity and its treatment. Herein we report a case of atypical rhinophyma in a 70-year-old female with longstanding rosacea. Histological evaluation of the shaved specimens showed angiofibromatous changes as opposed to classic rhinophyma. Concern for multiple angiofibromas led to screening of tuberous sclerosis complex but was negative. Treatment with excision and dermabrasion ultimately led to satisfactory results at 16 months post-procedure. We conclude that this case of atypical rhinophyma represents the rarely reported FVR. We report this case in an effort to increase the awareness of this rare variant of rhinophyma which shares features of facial angiofibromas. We summarize clinical recommendations for patients with multiple angiofibromas in addition to a review of similar cases reported in the literature.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jonathan Miles, MD, MPH