Rhinophyma

IntroductionThe Flash-lamp pulsed dye laser (FPDL) is nowadays considered the most precise laser currently on the market for treating superficial vascular lesions. In this study, we gathered data from 10 years of experience regarding dye laser treatment of patients presenting vascular malformations such as telangiectasia, rhinophyma, port-wine stain, cherry and spider angioma and vascular tumours.MethodsSubjects were enrolled from 2013 to 2023 based on the vascular anomalies they presented. They underwent different treatment sessions with the FPDL device.ResultsThe age-range distribution by vascular anomaly confirmed that haemangiomas are typical in children while rhinophyma is a condition very common in older adults. A difference in sex distribution showed that pathologies such as telangiectasias typically affect women whereas rhinophyma is more frequent in men. Most of the treatments interested the face area but no permanent side effects were registered.ConclusionsOur 10 years of experience with FPDL demonstrated good results in a wide range of applications for the treatment of different vascular anomalies. The absence of long-term side effects and bearable pain during the treatment makes it a valuable solution for the resolution of benign tumours also in very young patients.

PurposePhymatous rosacea is a chronic and disfiguring subtype of rosacea, mainly affecting the nose and leading to the development of rhinophyma. This condition manifests with erythema, enlarged pores and increased sebum secretion, progressing to textural alterations and nasal hypertrophy. Ablative CO2 laser resurfacing has emerged as a preferred approach, offering hemostatic control and favorable cosmetic outcomes. This case series presents our treatment experience with a non-fractional ablative CO2 laser resurfacing under local anesthesia for severe rhinophyma patients.MethodsA Retrospective case series of patients with severe rhinophyma treated with an ablative CO2 laser between December 2010 and March 2020 in our laser unit. Post-procedure aesthetic outcome was assessed by the treating physician 3 months following treatment and patients were asked to complete a long-term follow-up questionnaire.ResultsSixteen patients (15 males) were included, of which 13 patients (81%) had completed the questionnaire on an average of 15 months following treatment (range 2-24 months). Patient satisfaction following treatment was high, with an average satisfaction score of 7.9 out of 10 (range 4-10). Post-procedure aesthetic outcome was rated as very good or excellent in 13 patients (81%, with 75% or greater improvement). Among the 13 patients who completed the questionnaire, 11 (85%) indicated that they would recommend this treatment to others with a similar condition.ConclusionNon-fractional, ablative CO2 laser resurfacing performed under local anesthesia, has proven to be a safe, effective and well-tolerated treatment for severe rhinophyma, yielding sustainable results and high satisfaction rate.

Rhinophyma, a severe manifestation of rosacea, predominantly affects Caucasian males aged 50-70 and is characterized by thickening and enlargement of the nasal skin. The condition can seriously both impact cosmetic appearance and obstruct nasal breathing. While its appearance is distinct, conditions such as basal cell carcinoma can mimic it, complicating diagnosis. Treatment options for rhinophyma range from medical therapies to surgical interventions, with CO2 laser resurfacing emerging as the gold standard due to its precision and minimal blood loss. This retrospective case series evaluates the long-term efficacy and patient satisfaction of CO2 laser treatment in 11 male patients treated between 2015 and 2023 at the Karolinska University Hospital. The results revealed sustained positive outcomes, with 92% of patients reporting high satisfaction and 55% experiencing improved nasal airflow post-procedure. Despite some instances of hypopigmentation and scarring, no major side effects were reported. The study supports CO2 laser treatment as a safe and effective option for moderate to major rhinophyma in Caucasian male patients with Fitzpatrick skin types I-III. The importance of considering skin type, where extra caution must be employed when treating skin types IV-VI, should be emphasized as the treatment.

IntroductionThe clinical manifestations and presentation of rhinophyma closely resemble those of hypertrophic scar tissue, both presenting as firm, fibrotic growths. Despite this phenotypic similarity, a critical divergence is observed following surgical intervention: the affected skin in rhinophyma can revert to its normal state without scar recurrence, a favorable outcome starkly contrasting with the behavior of hypertrophic scars. The underlying mechanisms for this phenomenon have yet to be elucidated. The aim of this study is to uncover the cellular and molecular disparities between these two pathological conditions using single-cell sequencing technology to resolve this clinical paradox. The objective of this study is to compare the single-cell transcriptomic profiles of rhinophyma and hypertrophic scar tissues to identify key cell types and molecular pathways that may account for the distinct healing fate of rhinophyma post-surgery and provide novel insights for the prevention and treatment of hypertrophic scars.Methods and resultsWe isolated single cells from rhinophyma and hypertrophic scar tissues and conducted transcriptomic analysis using high-throughput single-cell RNA sequencing technology. Employing bioinformatics methods, we analyzed the data to identify differentially expressed genes and cellular subpopulations. Our results indicate that epithelial cells in hypertrophic scar tissues exhibit distinct fibrotic characteristics not observed in rhinophyma tissues. Vascular structures in hypertrophic scar tissues are enveloped by a significant number of stromal cells, in contrast to the leaky vascular profiles observed in rhinophyma tissues. Furthermore, keratinocytes in hypertrophic scars display disordered proliferation, while the number of immune cells in rhinophyma is significantly higher than in hypertrophic scar tissues.ConclusionThese findings reveal fundamental differences in cellular composition and functionality between rhinophyma and hypertrophic scar tissues, the intrinsic differences in the tissue microenvironment predispose them to divergent healing trajectories following the same insult, offering new perspectives on the healing process of rhinophyma post-surgery and potentially providing molecular targets for the development of scar prevention strategies.