If you are suffering from early stage rhinophyma you may like to consider accutane. There are some good, recently published articles that focus on rosacea and low-dose accutane. It is more difficult to find studies that specificially address treating rhinophyma with accutane.
Unfortunately doctors are finding it harder and harder to prescribe accutane. The wikipedia page on iPledge (the mandatory distribution program in the United States for isotretinoin) has the following quote on how hard it is becoming to get accutane.
In the RxDerm dermatology user group, a physician said, “It will be easier to get a firearm, an abortion or Thalidomide, than to obtain this safe and important medication.”
See Also: Dermatologists Frustrated With Problematic iPledge Program, AAD 64th Annual Meeting, Focus session, March 6, 2006
Hopefully good, peer-reviewed medical data may help you explore accutane as a rhinophyma treatment option.
CONTINUING MEDICAL EDUCATION: Rosacea: II. Therapy (Full Article PDF) J Am Acad Dermatol 2004;51:499-512, Michelle T. Pelle, MD, Glen H. Crawford, MD, and William D. James, MD, Boston, Massachusetts, and Philadelphia, Pennsylvania
Page 7:
Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma [70][75]. The most significant regression has been noted in younger patients with less advanced disease [75].
Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change [76][77].
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Phymatous subtype
Isotretinoin monotherapy is beneficial for early to moderate phymatous rosacea. Advanced phyma should be treated with surgical therapy or the combination of surgery followed by isotretinoin therapy. Surgical approaches to the reshaping of rhinophyma have included the use of a heated scalpel, electrocautery, dermabrasion, laserablation, tangential excision combined with scissor sculpturing, and radio frequency electrosurgery. Often a combination of these approaches is used to obtain the best aesthetic result [76][117][118].
These 2 short extracts refer to the following papers:
- [70] Schmidt JB, Gebhart W, Raff M, Spona J. 13-cis-Retinoic acid in rosacea. Clinical and laboratory findings. Acta Derm
Venereol 1984;64:15-21. - [75] Irvine C, Kumar P, Marks R. Isotretinoin in the treatment of
rosacea and rhinophyma. In: Marks R, Plewig G, editors. Acne
and related disorders: proceedings of an international sym-
posium. London: Martin Dunitz; 1988. p. 301-5. - [76] Lloyd KM. Surgical correction of rhinophyma. Arch Dermatol
1990;126:721-3. - [77] Jansen T, Plewig G. Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities.
Facial Plast Surg 1998;14:241-53. - [117] Kotrajaras R, Kligman AM. The effect of topical tretinoin on photodamaged facial skin: the Thai experience. Br J Dermatol
1993;129:302-9. - [118] Kligman AM, Leyden JJ. Treatment of photoaged skin with topical tretinoin. Skin Pharmacol 1993;6:78-82.
The full article: Rosacea: II. Therapy is available via a PDF download.
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