Photo Rounds

Enlarged nose

A 61-year-old man asked his family physician (FP) to look at his enlarged nose, which had worsened over the past 5 years. The patient said his face would also become red in warm weather—especially across his cheeks.

What's your diagnosis?


The FP diagnosed rhinophymatous rosacea in this patient (along with erythematous rosacea on his cheeks). Rhinophymatous rosacea is characterized by hyperplasia of the sebaceous glands that form thickened confluent plaques on the nose known as rhinophyma. This hyperplasia can cause significant disfigurement to the forehead, eyelids, chin, and nose. Nasal disfiguration is seen more commonly in men than in women.

The FP prescribed doxycycline 100 mg twice daily and topical metronidazole gel 1% daily. During a follow-up appointment one month later, the patient noted that his cheeks improved but he did not see any changes in his nose. The FP offered to send him in for a surgical procedure to treat the rhinophyma. However, the patient was not interested in surgery at the time and continued the prescribed treatment.

Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Rosacea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:659-664.

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