Rhinophyma (Alcoholic Nose)

Rhinophyma (Alcoholic Nose)

A ruddy, misshapen nose sometimes seen as a red flag for alcoholism.

Rhinophyma is a vexing skin condition, though the word itself may not spark immediate recognition. Its more common colloquial names — alcoholic nose, bulbous nose, and brandy nose are three examples — likely make it more evident.

Sufferers of rhinophyma experience a reddening (and sometimes purpling) of the nose. The shape of the nose also tends to shift, growing more bulbous and misshapen as the condition develops.

Treated early, the condition can usually be managed. Untreated, the nose can take on the appearance of that of a stereotypical heavy drinker. The late comedian W. C. Fields is one well-known example, with his large and bulbous sniffer. He referred to the ruddy lumps and bumps as gin blossoms.

What is rhinophyma nose?

A family history of rosacea increases the likelihood of rhinophyma — it is a subtype of severe rosacea — more commonly affecting fair-skinned men between the ages of 50 and 70. (Curiously, rosacea itself tends to afflict more women than men, but it hits men harder, particularly their noses.)

Symptoms of severe rosacea include:

  • Flushing and red patches on cheeks, chin, and nose
  • Pimplelike bumps and visible blood vessels on affected areas
  • Swelling and misshapen features, particularly the nose
  • Ocular rosacea, which includes a burning sensation or gritty feeling in the eyes, sometimes accompanied by conjunctivitis or swelling of the eyelids

To add insult to injury, not only does the sufferer endure flaming skin, swelling, and misshapen features, but there’s also a lingering social stigma attached to the condition.

Stereotypes of drunks with bulbous red noses have endured for generations. In recent years, medical experts have fought the assumption that rhinophyma is linked to heavy alcohol consumption. Google the term rhinophyma and plenty of resources pop up, stating that the so-called alcoholic nose is as likely to be suffered by teetotalers and tipplers alike.

That still seems to be the dominant professional opinion, though one recent study, “Rhinophyma Is Associated with Alcohol Intake,” published in the Journal of the American Academy of Dermatology, suggests that there may be a link after all.

It should be noted that the National Rosacea Society cautions against going back to naming alcohol consumption the culprit. The dermatology article is only one study — and a small one at that — and factors such as a genetic predisposition to rosacea and toward alcohol’s tendency to cause vasodilation should be considered when rhinophyma is diagnosed.

Since alcohol is a vasodilator, causing blood vessels to widen and the skin to flush, slowing one’s intake of liquor can help ease flare ups. However, many other factors can cause blood to flow to the skin, including spicy foods, temperature extremes, vigorous exercise, medications, and stress. So-called demon rum may not be so diabolical in such cases.

What causes rhinophyma?

A doctor can typically diagnose rhinophyma with a visual exam. The diagnosis typically follows a confirmation of rosacea.

Rosacea is a chronic but treatable condition that primarily affects the central part of the face. It is often characterized by flare-ups and remissions. Although it may develop in many ways and at any age, patient surveys indicate that it typically begins any time after age 30 as flushing or redness on the cheeks, nose, chin, or forehead that may come and go.

Symptoms of rhinophyma:

  • Redness at the tip of the nose
  • Misshapen or bulbous nose
  • Red or purple discoloration
  • More visible blood vessels
  • Pimples and inflamed bumps
  • Enlarged pores
  • Skin scarring and/or pitting
  • Thickened skin that looks waxy or rough
  • Oily or dry skin

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How do you treat rhinophyma?

Often a rosacea diagnosis and treatment can be enough to head off rhinophyma, according to the National Rosacea Society. Medical therapy and making some lifestyle tweaks can keep rosacea in check and curb the onset of rhinophyma.

Once rosacea is diagnosed, topical and oral antibiotics can be used to treat the skin condition. Topical medications like tretinoin (Retin-A) may keep inflammation at bay. The National Rosacea Society suggests keeping a journal to note triggers. According to its data, more than half of people with rosacea cited these most common triggers:

  • Sun exposure
  • Emotional stress
  • Hot weather
  • Wind
  • Heavy exercise
  • Alcohol consumption (red wine is the most cited culprit)
  • Hot baths

Foods and drinks (not just alcohol) can also trigger rosacea, including caffeine, dairy, and spices and seasonings (especially ones with the substance capsaicin, such as cayenne pepper and red pepper).

If lifestyle changes and topical treatments don’t help, and rosacea has advanced to the rhinophyma stage, surgical options tend to be the next logical step.

A health care professional may also opt for further testing, including a biopsy, to screen for a deeper problem such as malignancy. According to an ePlasty.com paper, a three-pronged approach that includes shaving off the excess skin, sculpting, and mild dermabrasion has led to good results.

Knowing if you’re more vulnerable to rosacea, seeing a professional (the earlier, the better), and following a treatment course that includes noting triggers — including alcohol, potentially — can help ward off the most frustrating effects of rhinophyma. While there is no outright cure, those afflicted can take comfort in knowing that there are options to help control the condition.

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