treating rhinophyma with x-rays

Rhinophyma treated with kilovoltage photons

Australasian Journal of Dermatology, Volume 46 Page 88 - May 2005

CASE REPORT, Marketa Skala, Geoffrey Delaney, Vincent Towell and Nevin Vladica

A 72-year-old retired truck driver presented with a 10-year history of rhinophyma and was successfully treated with 90-kV photons to a total dose of 40 Gy in 20 daily fractions. A brief discussion of radiotherapy in the treatment of rhinophyma follows.

Some extracts from the paper ;

The patient understood that radiotherapy had no routine role in the treatment of rhinophyma, and that ther was only one recent journal article supporting its use. The small risk of late effects, including radiation-induced malignancy, was discussed and written informed consent was obtained.

Treatment was in the supine position, with the nose protruding through a 5.1 x 5.5 cm lead shield cut-out. A 900kV, 28.1mA X-ray beam of 3 mm aluminium half-value layer was used at a focus-to-source distance of 30cm. An incident dose of 40Gy was delivered in 20 treatments over 32 days to the outlined area.
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Two weeks after the completion of radiotherapy the skin of the nose was mildly erythematous, and appeared smoother, with a reduction in the number of pits and issures.
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At 6 months there was no erythema, and no signs of suppuration. Eighteen months after radiation therapy the patient enjoys a significant improvement in the appearance of the nose and has not required any further treatment.

Discussion

The use of radiotherapy in the treatment of skin malignancies is well documented. The incidence of coexisting skin cancers in rhinophyma has been estimated to be as high as 10% for BCC. Squamous cell carcinoma, angiosacrcoma and sebaceous carcinoma have also been reported.

The beneficial effects of radiotherapy in rhinophyma are probably due to a reduction in the sizee and number of the sebaceous glads. Skin bipoies following a course of ionizing radiation show widespread atrophy of the pilosebaceous units.
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Routine use of radiation in the treatment of hinophyma is to be discouraged. However, as our case report illustrates, it might be an option for patients who refuse or are unsuitable for surgery, and are unable or unwilling to ramain on long-term antibiotic therapy.

• Abstract Online (full copy available from author).
• PubMed Extract
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