The development of an enlarged, red bulbous nose was once thought to be caused by heavy alcohol consumption, but this is not the case. Rhinophyma occurs equally in those who do not drink at all and those who drink alcohol excessively.
Rhinophyma typically afflicts white males between 40 and 60 years of age. It is 12 times more common in men than women. It is more common in individuals of English or Irish descent and is practically inexistent in blacks.
It begins with rosacea which progresses to acne rosacea. With time, the vessels of the nose become progressively dilated. Multiple cysts and pustules grow in the thickened oily skin. As sebaceous glands become more and more hypertrophied, the nasal tip widens. As the deformity worsens, pits, nodules, fissures, lobulations, and pedunculations distort the nose into a grotesque organ.
Histopathologically there is hyperplasia and hypertrophy of the sebaceous glands, and the ducts become elongated, dilated, and plugged. There is irregular fibrous tissue proliferation with varying degrees of inflammatory cell infiltration. Foreign body reactions are not unusual. Bacteria and Demodex folliculorum mites are regularly encountered in the pilosebaceous units of the nasal tip.
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