Rosacea treatment: Thickening skin

Before and after extensive surgery to treat thickened skin on the nose.

If you’re diagnosed with rosacea, pay close attention to your skin. If you notice firm, rounded bumps or thickening of the skin on your face, it’s time to see a dermatologist. These changes are most common on the nose. You may also notice them on your chin, forehead, eyelids, or one or both ears.

The medical term for these changes is phyma (fie-ma). When thickening skin develops on the nose, it’s called rhinophyma.

The earlier phyma is diagnosed and treated, the better. Your dermatologist may be able to treat it with medication if caught early enough. The more the skin thickens, the more difficult treatment becomes.

Allowed to progress, phyma can also cause medical problems. When it affects the nose, you can have trouble breathing. Swollen, thick eyelids can cause problems with your eyesight.

To treat phyma, dermatologists use one or more of the following.

Medicine you take

Isotretinoin: Approved to treat severe acne, this medicine may also prevent phyma from worsening.

While this medication can prevent the thickening skin from worsening, it cannot get rid of existing thickened skin. Only surgery can do that.

Because isotretinoin can cause serious birth defects in woman who are pregnant, this medication is not a treatment option for everyone. Women who have rosacea, however, rarely develop thickening skin.

Surgery

When thickened skin needs to be removed, your dermatologist may refer you to a dermatologic surgeon. Surgery to remove phyma is complex. It often requires using different surgical procedures to remove the excess skin and reshape the nose or other area of your face.

After surgery, you may need to take isotretinoin for a while to maintain the results.

You’ll also need to find and avoid your rosacea triggers. Gentle skin care and sun protection are also essential. You’ll find more information about this at:

• 6 skin care tips dermatologists give their patients
• How to prevent rosacea flare-ups

Image used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2016;74:1276-8).

References
Angelucci DD. “Rhinophyma progress slowed with swift diagnosis, treatment.” Dermatol Times. June 1, 2011. Last accessed August 2017.

Pelle MT. “Rosacea.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:703-9.

Pelle MT, Crawford GH, et al. “Rosacea: II. Therapy.” J Am Acad Dermatol. 2004;51(4):499-512.

Rosamilla LL. “Rosacea treatment schema: An update.” Cutis. 2017;100(1):11-13.

Two AM, Wu W, et al. “Rosacea Part II. Topical and systemic therapies in the treatment of rosacea.” J Am Acad Dermatol. 2015;72:761-70.