Ablative CO2 Laser Treatment of Rhinophyma in People of Color: A Case Series

Rhinophyma is the result of progressive acne rosacea, which results in hypertrophy and fibrosis of sebaceous glands and connective tissues of the nose. The skin soft tissue envelope of the nose becomes bulkier and heavier relative to the underlying structural supportive framework of the nose over time, resulting in nasal airway obstruction and disfigurement that adversely impact quality of life. It is classically taught that rhinophyma is a disease that more commonly affects men, White people, and those in middle age. There are multiple treatment modalities available for rhinophyma aimed at surgical reduction of the overgrown skin soft tissue envelope, including CO₂ laser-assisted surgical excision. Rhinophyma also occurs in people of color, including Latin Americans, Native Americans, Black people, and others, although the condition is rare in these populations. There is less written about the limits of laser-related treatments in these populations. We present a case series of 7 patients with melanated skin and moderate to severe rhinophyma who were treated with CO₂ laser excision, with significant improvement in nasal appearance and functional nasal obstruction as a result. Three patients in the series developed some degree of scarring in the supratip and tip region that did not significantly deter the overall improvement in nasal aesthetics from treating the disease. A more conservative treatment plan with respect to the depth of resection may have limited scarring, or perhaps the traditional teaching to approach laser treatments in patients with melanated skin with caution due to risks of scarring is supported here.