Phymatous rosacea is a rare and severe form of rosacea that manifests as disfiguring soft-tissue hypertrophy and hyperplasia as well as fibrosis of the sebaceous glands. 1 Treatments for phymatous rosacea include pharmacotherapeutic and surgical modalities; most cases are treated surgically. Surgical modalities vary, ranging from cryosurgery to conventional excision, and consensus guidelines for surgical management do not exist because data are largely limited to case reports and small case series. 2 The Versajet II Hydrosurgery System (Smith-Nephew) is a high-pressure, pulsatile lavage system that has been used for phymatous rosacea and then only for rosacea of the nose (rhinophyma). We present the case of a patient with phymatous rosacea of the nose, cheeks, and chin who was successfully treated with the Versajet II Hydrosurgery System beyond just the nose region.
Case Report
A 75-year-old man presented to the dermatology clinic for evaluation of severe phymatous rosacea of the nose, cheeks, and chin that had been present for several years. Examination revealed verruciform, thickened, erythematous skin of the nose, cheeks, and chin; marked blue-gray hyperpigmentation on the neck and hands; generalized facial redness; and cystic and depressed scars (Figure 1). The patient had been treated with topical metronidazole without response, and isotretinoin worsened the symptoms. He also was taking minocycline but stopped it at our request because of concern that the drug was causing the blue-gray hyperpigmentation. The patient was referred to plastic surgery and tangential excision was recommended. Fractional ablative laser therapy was considered but deferred because the patient wanted quicker results.
Figure 1. A and B, Severe phymatous rosacea of the nose, cheeks, and chin, as well as generalized rosacea and hyperpigmentation of the sclera.
The patient received tangential excision of the phymatous areas of the chin, bilateral cheeks, and nose with the Versajet II Hydrosurgery System until a pleasing contour was noted. At 1-month follow-up, the patient had an excellent contour of the nose, cheeks, and chin (Figure 2).
Figure 2. A–C, Marked improvement in facial contour after tangential excision of phymatous skin of the nose, cheeks, and chin.
Comment
Phymatous rosacea is a rare disfiguring disease that most commonly presents on the nose but also can affect the chin, cheeks, eyelids, ears, and forehead. Incidence is greater in individuals of Scottish descent and in men due to the influence of androgens. The etiology of the condition is unknown.1