If you are suffering from early stage rhinophyma you may like to consider accutane as a treatment.
There are some good, recently published articles that focus on more general rosacea and low-dose accutane.
Currently, it is comparatively more difficult to find studies that specifically address treating rhinophyma with accutane though.
Accutane is Tricky
Additionally, and 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.
Available Rhinophyma + Accutane Research
Following are the best known published papers that I can find. These papers suggest that accutane may be a reasonable treatment for early stage rhinophyma. As more good references surface I will add them to this list. If you see a relevant study, please let me know. thanks.
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
Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma . The most significant regression has been noted in younger patients with less advanced disease .
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 .
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 .
These 2 short extracts refer to the following papers, which you may also find as helpful background:
-  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.
-  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 symposium. London: Martin Dunitz; 1988. p. 301-5.
-  Lloyd KM. Surgical correction of rhinophyma. Arch Dermatol 1990;126:721-3.
-  Jansen T, Plewig G. Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities. Facial Plast Surg 1998;14:241-53.
-  Kotrajaras R, Kligman AM. The effect of topical tretinoin on photodamaged facial skin: the Thai experience. Br J Dermatol 1993;129:302-9.
-  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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