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April 2005
By Stephen M. Schleicher, MD, and Yanni
Ni, MD
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CASE:
A 43-year-old woman presents with a large, bulbous, ruddy
nose that, according to her, has enlarged gradually over the
past several years. She has been taking oral doxycycline and
applying topical metronidazole. She is moderately obese and
denies any history of systemic disease. Examination reveals
marked nasal hypertrophy and erythema, as well as papules
and pustules on her cheeks and chin.
WHAT IS YOUR DIAGNOSIS?
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Rhinophyma, characterized by telangiectasia, erythema, papules,
pustules, and tissue hypertrophy of the nose, is generally regarded
as a severe form of rosacea. Its cause is unknown. The disease
is most common in persons with a fair complexion. Rhinophyma
is significant primarily because of the resulting cosmetic disfigurement
and the associated social stigma based on the widely held perception
that this condition results from alcoholism. When advanced,
it warrants consideration of surgical or laser reshaping of
the nose, or both. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Ni is a visiting physician and a graduate of the Beijing
Medical University in Beijing, China.
Emerg Med 37(4):39, 2005
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