Rhinophyma treatment: Prevention and early stages

Table of Content:
Why does rhinophyma occur? | Can you prevent it? | Early stages | Treatment options | Get a prescription | FAQ

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What is rhinophyma and why does it happen?

Dr. Amit Om, board-certified dermatologist says that rhinophyma is a skin condition characterized by a thickened, enlarged, and bulbous appearance of the nose. It often develops gradually and is most commonly associated with severe or advanced rosacea, a chronic inflammatory skin disorder¹.

Why does rhinophyma occur?

Dr. Om says that rhinophyma develops due to chronic inflammation and excess tissue growth. Over time, the following changes contribute to its formation:

• Enlarged sebaceous (oil) glands: These become overactive, leading to thickening of the skin.
• Tissue hypertrophy: The connective tissue and glands in the nose grow excessively, resulting in a bumpy, irregular surface.
• Chronic inflammation: Repeated flare-ups from rosacea or untreated inflammation worsen skin texture and vascular changes.
• Poorly controlled rosacea: Not everyone with rosacea will get rhinophyma, but those with untreated or advanced cases are at higher risk².

Can you prevent rhinophyma?

Dr. Om says that you cannot fully prevent rhinophyma, the following steps can help minimize your risk of developing it:

• Treat rosacea early and consistently: Use topical or oral medications (like metronidazole, azelaic acid, or doxycycline) as prescribed to control inflammation.
• Avoid triggers: Heat, sun, spicy food, alcohol, and stress can worsen rosacea. Keeping a trigger diary can help you identify and avoid your personal triggers.
• Use sunscreen daily: Sun exposure can exacerbate rosacea and skin thickening, so daily SPF is critical.
• Moisturize and protect the skin barrier: A healthy barrier reduces inflammation and keeps the skin resilient.
• Watch for signs of thickening: If your nose skin starts to feel bumpy, firmer, or more oily, see a dermatologist promptly.
• Consider laser or light therapy: Early laser treatment (like CO2 or pulsed dye lasers) can reduce redness and excess tissue before it becomes severe.

What are the early stages of  rhinophyma?

Dr. Om says the early stages of rhinophyma are often subtle and can be easy to overlook, because it can be mistaken for common rosacea. This stage is sometimes referred to as pre-rhinophyma or early phymatous rosacea, and it includes:

Early signs of rhinophyma

• Persistent redness (erythema): The nose may appear red or flushed, often worsening with heat, alcohol, or spicy foods.
• Swelling or puffiness: Mild, intermittent swelling may occur, especially around the tip of the nose.
• Thickened skin texture: The skin may begin to feel firmer, slightly bumpy, or rough.
• Visible pores: Pores may enlarge, especially on the nasal tip and sides.
• Increased oiliness: The nose may start to look greasy due to overactive sebaceous glands.
• Spidery red or purple veins on your nose: These are called telangiectasias, small dilated blood vessels that often appear with rosacea and can signal ongoing inflammation that may contribute to tissue changes over time³.

At this stage, inflammation is active, but permanent structural changes haven’t fully set in, making it the best time for early intervention with medications or laser therapy to prevent progression.

How can I get a prescription for rhinophyma?

If you want to get a prescription for rhinophyma/rosacea. You can have a consultation with a board-certified dermatologist via Miiskin for $59. Medication renewals start at $39.

Be aware that you are only eligible to get a rhinophyma prescription if you are in the early stages. If your nose is severely affected by this condition, topical or oral medications will not be effective any more.

How do you treat early rhinophyma? 

Dr. Om says topical treatments are highly effective in managing early-stage rhinophyma and underlying rosacea, making them a valuable tool for slowing progression and preserving skin health. He emphasizes that the early intervention and treatment with topical treatment is to help reduce inflammation, control redness, and maintain a smoother, healthier appearance. Here are some of the most effective treatment creams for addressing rhinophyma in its early or mild stages.

Rhinophyma treatment creams 

Ivermectin

Ivermectin is an anti-inflammatory and anti-parasitic cream that helps reduce the number of Demodex mites, microscopic organisms that are found in higher numbers on the skin of rosacea patients. These mites may trigger inflammation that leads to rhinophyma over time. Ivermectin helps by lowering mite populations and calming immune responses, which reduces the cycle of redness, swelling, and eventual skin thickening⁴.

Metronidazole

Topical metronidazole works for rosacea by reducing inflammation and calming the skin, which is essential in early rhinophyma that stems from chronic rosacea. It doesn’t shrink tissue or oil glands directly, but it suppresses the ongoing irritation and redness that can drive tissue thickening over time. By keeping inflammation controlled, it helps prevent progression to more severe stages⁵.

Epsolay (Benzoyl Peroxide 5% in Sol-Gel)

Epsolay is a prescription cream that delivers benzoyl peroxide in a silica-based Sol-Gel, designed specifically for rosacea-related bumps and lesions. It has anti-inflammatory and antibacterial effects, helping to reduce pustules and inflammation without the irritation often caused by traditional benzoyl peroxide. By calming inflammatory lesions early on, Epsolay may help manage the triggers that contribute to rhinophyma development in its initial stages⁶.

Topical minocycline (Amzeeq)

Topical minocycline (Amzeeq) is a newer option that delivers the anti-inflammatory and antibacterial benefits of tetracyclines directly to the skin, with less risk of systemic side effects. It helps reduce rosacea-associated papules and pustules by targeting inflammation and skin bacteria. By lowering chronic irritation and pustule formation, topical minocycline may help prevent the inflammatory cycles that contribute to early tissue changes seen in rhinophyma⁷.

Azelaic Acid

Azelaic acid 15% (Finacea) works by gently exfoliating the skin, reducing swelling, and killing bacteria on the surface. It also helps to clear out clogged pores and reduce redness⁸. This is especially useful if your skin is becoming bumpy or rough in the early stages of rhinophyma. By improving skin turnover and reducing oxidative stress, it slows the process of thickening and oil buildup.

Brimonidine (Mirvaso)

Brimonidine (Mirvaso) is a topical gel that works by constricting blood vessels in the skin, offering quick and temporary relief from facial redness. It typically begins working within 30 minutes and lasts up to 12 hours. It’s most effective for immediate redness control but may cause rebound flushing in some users⁹.

Oxymetazoline (Rhofade)

Oxymetazoline (Rohfade) is a topical cream that also reduces redness by narrowing superficial blood vessels. It tends to have a slower onset than brimonidine but offers longer-lasting results and may be better tolerated for daily use in sensitive skin^10.

What is the most effective treatment for rhinophyma?

Isotretinoin (Accutane) is one of the most effective medications in treating early-stage rhinophyma, as it reduces oil gland activity, inflammation, and helps slow down the thickening of nasal skin. When started early, it may prevent progression and minimize visible changes. However, in moderate to advanced cases, surgical or laser procedures are required to remove excess tissue and restore the nose’s shape. 

FAQ about rhinophyma treatment

What are the symptoms of rhinophyma?

Symptoms of rhinophyma typically develop gradually and affect the appearance and texture of the nose. Common signs include:

• Thickened skin on the nose: The skin becomes progressively thicker, especially on the tip and lower part of the nose.
• Bulbous or enlarged nose: The nose may appear swollen, rounded, or misshapen.
• Bumpy or irregular surface: The skin develops a rough, uneven texture with visible nodules or lumps.
• Enlarged pores: Pores on the nose often appear dilated or more pronounced.
• Redness: Persistent redness is common, often due to increased blood vessels (telangiectasia).
• Oily skin: The affected area may feel greasy due to enlarged sebaceous glands.
• Visible blood vessels: Small blood vessels may become prominent across the nose.
• Disfigurement (in severe cases): If untreated, rhinophyma can lead to significant cosmetic and functional changes, sometimes obstructing the nostrils¹¹.

What triggers rhinophyma?

Rhinophyma is triggered by the long-term progression of rosacea, particularly when inflammation is chronic and untreated. While the exact cause isn’t fully understood, several factors are known to contribute to its development:

• Chronic rosacea – Especially untreated or poorly managed rosacea with persistent redness, swelling, and inflammation.
• Excess oil production – Overactive sebaceous glands contribute to skin thickening and enlargement of pores.
• Frequent facial flushing – Triggered by heat, alcohol, spicy foods, stress, or sun exposure, which increases blood flow and worsens inflammation.
• Demodex mites – These skin mites may provoke immune responses that contribute to rosacea and phymatous changes.
• Lack of treatment – Delayed or inconsistent rosacea management allows the condition to progress into more severe forms, like rhinophyma.

At what age does rhinophyma start?

Dr. Om says that rhinophyma typically develops gradually over many years and most often appears in middle-aged to older adults, particularly men over 50. It is rare in younger people, and while it can technically start earlier, it usually follows a long-standing history of rosacea, which itself often begins between ages 30–50. So while rhinophyma doesn’t have a strict age limit, it almost never shows up in childhood or early adulthood.

When does rosacea turn into rhinophyma?

Dr. Om says that rosacea can progress into rhinophyma over time, but this usually over many years. Here’s when and how rosacea may begin to turn into rhinophyma:

Typical rhinophyma progression timeline

• Early rosacea (30s–40s): Redness, flushing, visible vessels, and sometimes acne-like bumps begin to appear. Skin may be sensitive or dry.
• Persistent rosacea (40s–50s): Without consistent treatment, chronic inflammation can lead to long-term swelling and enlarged oil glands, especially on the nose.
• Phymatous changes (50s+): Over time, the tissue on the nose begins to thicken, pores enlarge, and the surface becomes bumpy or irregular—early signs of rhinophyma.
• Advanced rhinophyma: The nose becomes bulbous, deformed, and nodular, with permanent tissue overgrowth.

Why are men more affected by rhinophyma?

Dr. Om says that there several factors may explain why rhinophyma is significantly more common and severe in men:

• Larger sebaceous glands: Men naturally have more active and larger oil glands, especially on the nose. This increases the risk of glandular overgrowth and skin thickening.
• Thicker skin: Male skin is generally thicker and more prone to tissue buildup, which contributes to the nodular, bulbous look of rhinophyma.
• Hormonal influence: Androgens (male hormones like testosterone) can stimulate sebaceous gland activity, potentially worsening the progression of phymatous changes.
• Delayed treatment: Studies suggest men may be less likely to seek early dermatological care for rosacea, allowing inflammation to progress unchecked over time.

Can women get rhinophyma?

Dr. Om says that rhinophyma can also occur in women, but it’s much less common. The condition is overwhelmingly more frequent in men, possibly due to hormonal differences or thicker skin and larger sebaceous glands in the male nose. When it does occur in women, it tends to be less severe and less disfiguring than in men. However, it can still cause significant cosmetic and psychological distress, so early treatment is important regardless of gender.

Can Accutane help prevent or treat rhinophyma?

Dr. Om says that Accutane (isotretinoin) can be helpful in shrinking the nose due to rhinophyma, particularly when used in the early stages. It does this by significantly reducing oil production and inflammation—two key factors in the development of rhinophyma—it can help shrink enlarged sebaceous glands and minimize skin thickening. However, it’s important to note that Accutane is most effective before permanent tissue overgrowth occurs; once the nose becomes visibly enlarged or deformed, surgical or laser treatments are typically needed. Early intervention with Accutane may reduce the risk of progression and delay or even prevent the need for more invasive procedures.

How do you shrink rhinophyma?

Dr. Om says that to “shrink rhinophyma” at an early stage, the key is to control inflammation and reduce sebaceous gland activity before permanent tissue overgrowth occurs. Early intervention with topical treatments such as metronidazole, azelaic acid, or ivermectin can help reduce redness, swelling, and acne-like lesions. For more progressive or stubborn cases, oral isotretinoin may be prescribed, as it significantly reduces oil production and can slow or even reverse early thickening of the nasal skin. Combined with sun protection, trigger avoidance, and consistent skincare, these treatments can help minimize phymatous changes and potentially prevent the need for surgical intervention later on.

How do you slow down rhinophyma?

Dr. Om says that to slow down rhinophyma, the key is to control rosacea early and consistently, reduce inflammation, and minimize oil gland activity. Using topical medications like metronidazole, azelaic acid, or ivermectin can help calm the skin and reduce redness. In more persistent or early phymatous cases, oral isotretinoin may be prescribed to shrink overactive sebaceous glands and prevent further skin thickening. Regular follow-up with a dermatologist ensures that changes in skin texture are caught early, so intervention can be adjusted before rhinophyma becomes advanced.

Can early rhinophyma be reversed?

Yes, Dr. Om says that early rhinophyma can often be reversed or significantly improved if treated promptly. In its early stages—when symptoms include redness, swelling, enlarged pores, and mild thickening—medical treatments like topical anti-inflammatories (e.g., metronidazole, ivermectin), oral antibiotics, or oral isotretinoin can reduce inflammation, shrink oil glands, and prevent further tissue buildup. Early diagnosis and proactive treatment are crucial for the best outcome.

Can rhinophyma go away?

Dr. Om says that rhinophyma is a progressive condition and does not go away on its own, especially once the skin has started to thicken and develop permanent changes. However, early-stage rhinophyma can often be managed or slowed significantly with the right treatment. If caught early—before major tissue overgrowth—topical medications, oral isotretinoin, and laser therapy can reduce inflammation, shrink oil glands, and help preserve the skin’s normal structure. 

Does alcohol cause rhinophyma?

Dr. Om says that alcohol does not directly cause rhinophyma, but it is considered a significant trigger in people with rosacea, the underlying condition that leads to rhinophyma. Alcohol—especially red wine and hard liquor—causes facial flushing and dilated blood vessels, which can worsen inflammation and accelerate the progression of rosacea over time. He also mentioned that rhinophyma can also occur in people who don’t drink alcohol at all.

Is rhinophyma progressive?

Dr. Om says that rhinophyma is indeed a progressive condition—meaning it tends to worsen over time if left untreated. The progression is often slow and may take years and it typically develops as a late-stage complication of rosacea, starting with subtle signs like redness, swelling, and enlarged pores on the nose. Over time, persistent inflammation and overactive sebaceous glands can lead to thickened, bumpy, and bulbous nasal skin. However, with early diagnosis, consistent treatment, and lifestyle changes, progression can be often slowed, or even partially reversed in its early stages.

How can I shrink my nose blood vessels?

Dr. Om says there are several prescription creams that can effectively reduce visible blood vessels and redness on the nose, particularly when linked to rosacea. Brimonidine (Mirvaso) and oxymetazoline (Rhofade) are topical vasoconstrictors that temporarily shrink blood vessels, providing quick but short-term relief from redness with daily use. Additionally, Ivermectin (Soolantra) targets inflammation and Demodex mites, helping calm the skin and reduce persistent flushing. Metronidazole and azelaic acid also fight inflammation and improve skin tone, which can make blood vessels less noticeable. 

Does rhinophyma only happen in the nose?

Dr. Om says rhinophyma refers to thickening and deformity of the nose, similar tissue overgrowth can occur in other areas of the face, though it is much less common. These variants include:

• Gnatophyma – affects the chin
• Metophyma – affects the forehead
• Otophyma – affects the ears
• Blepharophyma – affects the eyelids¹²
  

However, rhinophyma is by far the most common and well-known form of phymatous rosacea. It occurs because the nose has a high concentration of sebaceous glands, making it more prone to the overgrowth and thickening typical of this condition.

Article References:
https://www.ncbi.nlm.nih.gov/books/NBK544373/
https://www.webmd.com/skin-problems-and-treatments/what-to-know-about-rhinophyma
https://www.dermatologytimes.com/view/topical-rosacea-cream-creates-new-treatment-paradigm
https://www.ncbi.nlm.nih.gov/sites/books/NBK539728/
https://www.dermatologytimes.com/view/sol-gels-rosacea-cream-may-offer-patients-rapid-relief
https://www.dermatologytimes.com/view/topical-minocycline-shows-potential-effective-papulopustular-rosacea-treatment
https://pubmed.ncbi.nlm.nih.gov/18803456/
https://www.mayoclinic.org/drugs-supplements/brimonidine-topical-application-route/description/drg-20061302
https://pmc.ncbi.nlm.nih.gov/articles/PMC7891417/
https://www.webmd.com/skin-problems-and-treatments/what-to-know-about-rhinophyma
https://www.ncbi.nlm.nih.gov/books/NBK544373/

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