Unveiling the Histopathological Characteristics of Rhinophyma

A 60-year-old male patient came to the Dermatology outpatient department with multiple asymptomatic raised lesions over both sides of the nose for the past 10 years, which started as skin coloured raised lesions over the nose, initially small in size and gradually progressed to the current size. There was no history of pain, itching or bleeding from the lesion. There was no history of other constitutional symptoms, weight loss, loss of appetite, lesions elsewhere in the body, significant family history or history of alcohol intake. The patient did not give any proper history of previous treatment for the same. On examination, there was a bulbous outgrowth of size 2×2 cm with prominent pores and erythematous nodules over the ala of the nose, forehead and chin [Table/Fig-1]. A differential diagnosis of rhinophyma, lupus pernio and lymphocytoma cutis was considered based on the history and examination findings. A 4 mm punch biopsy was taken from the nose and it revealed orthokeratosis, flattened rete ridges, dermal perivascular and perifollicular lymphohistiocytic infiltrate with prominent sebaceous gland hyperplasia, along with lymphatic dilatation [Table/Fig-2a-c]. A final diagnosis of phyma was made with involvement of the nose, chin and forehead based on histopathological findings. The patient was started on a daily low dose of oral isotretinoin 10 mg OD for four weeks and was suggested other treatment modalities like excision followed by fractional CO2 laser, following which the patient was lost to follow-up.