Rhinophyma

Rhinophyma describes the growth of the nose in some patients with Rosacea. It is an uncommon complication and if it occurs it is almost always a man. The distal part of the nose thickens up. In time it develops a knobby appearance and the pores may be significantly enlarged. Large superficial blood vessels sometimes develop.

Treatment:

Treatment requires physical destruction of the excessive growth of sebaceous and fibrous tissue. Topical and oral medications do not help other than reducing inflammation. The vascular laser used for flushing and blood vessels may reduce the redness but not the size of the nose.

A variety of techniques have been used including dermabrasion, hot knife surgery, electrosurgery as well as laser removal of tissue.

Laser treatment is best achieved by using a CO2 laser. It can be used in a cutting mode (CW –continuous mode) to reduce the bulk of the nose. The Silktouch laser is ideal. The tissue is vaporized so that the shape of the nose can be remodeled. Care need to be taken not to over treat but scarring is uncommon. A danger in over correcting is contracture pulling up the tip of the nose.

Local anesthesia using nerve blocks and local infiltration is used or general anesthesia is the other alternative.

Healing usually takes 2-3 weeks. There is a yellow colour to the skin because the sebaceous glands are exposed. There is oozing from the pared tissue and crusting will develop.

Most patients are delighted with the response to treatment.

Minocycline (Minocin®, Dynacin®, Vectrin®)

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INTRODUCTION
Minocycline inhibits the growth of Propionibacterium acnes. Anti-inflammatory actions. Drug Class: Antibiotic, Anti-inflammatory-long acting tetracycline... | Read more ...

CLININCAL EXPERIENCE
Oral antibiotics have had a significant role in the treatment of inflammatory disease such as acne, rosacea, perioral dermatitis and others. Tetracycline has long been the first line antibiotic for acneform eruptions because of its efficacy and affordability although in inconvenience of divides doses on an empty stomach has compromised compliance in some. P. acnes resistance to Tetracycline and Erythromycin has meant looking elsewhere for an alternative antibiotic. Bacterial resistance to Minocycline has been much slower to develop... | Read more ...

INDICATIONS
Labeled Indications: Dermatologic Dermatologic: Acne vulgaris, Inflammatory acne, Anthrax, Chancroid, Granuloma inguinale, Lymphogranuloma venerum, Skin and soft tissue infections , Syphilis, Yaws... | Read more ...

PATIENT PROFILE
Any inflammatory acne or rosacea patient who is not likely to respond to topical therapy alone. If scarring present or nodulocystic acne a more aggressive approach may be necessary... | Read more ...

DOSING
Capsules: Minocycline 50 and 100mg (Minocin* Dynacin*) Suspension: Minocycline 50mg (Minocin* Dynacin*) Parenteral: Minocycline 100mg (Minocin IV*) ... | Read more ...

EFFICACY
Improvement in inflammatory lesion in acne is about a 20% reduction a month. It may take 1-2 months to see initial benefit. After 6 months there is an approximate 60-70% improvement in inflammatory acne counts. Studies over the last 20 years have shown that tetracycline, erythromycin, doxycycline and minocycline have about the same efficacy in acne... | Read more ...

COMPLIANCE
All tetracyclines are broad-spectrum bacteriostatic agents. They are well absorbed, although oxytetracycline and tetracycline should not be taken with food. Minocycline as well as Doxycycline are absorbed almost as well on an empty as full stomach... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Discard outdated tetracyclines as degradation products may be toxic. Not recommended in pregnancy and in children under 8 years of age as permanent enamel hyperplasia, discoloration of teeth, and inhibition of fetal skeletal growth may occur... | Read more ...

COST OF TREATMENT
Cost of treatment of 1 month of standard dose for acne: Minocycline 100 mg daily for 1 month $42. Tetracycline 1gm daily for 1 month ... | Read more ...

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