Social Isolation During COVID-19 Pandemic: Challenges of a Rhinophyma Patient Reluctant to Seek Treatment

Rhinophyma is a progressive dermatologic condition of the nose that is characterized by hypertrophic thickening of the skin, edema of the nasal pyramid, and hyperplasia of nasal sebaceous glands and connective tissue. We present a case of severe rhinophyma, where the patient delayed seeking treatment due to social isolation during COVID-19 and apprehension about surgery. Mask-wearing concealed the deformity and allowed it to worsen. We will demonstrate the surgical technique with a photo timeline, illustrating healing progression. This is a useful adjunct when counseling patients with rhinophyma on the expected post-operative course and appearance. A 67-year-old male patient presents with enlarging cysts and thickening epidermis on the nose resulting in large hypertrophic, nodular lesions and telangiectasias. His nose was deformed with multiple pedunculated lesions from the nasal dorsum, sidewalls, and along the alar rims. The largest lesion measured 5 cm; six were excised using electrocautery. Each sebaceous cyst was excised individually to create a more uniform surface. The remaining skin had severe rhinophyma. Loop electrocautery (LP) was used to excise the nasal dorsum and bilateral nasal sidewalls, the alar rims over the soft tissue triangle, and the nasal tip and over the columella. A 5-mm tip was used for finer elements, producing an improved nasal shape, and no cartilage was exposed. The nose was dressed with antibiotic ointment and nonadherent gauze with absorptive gauze overlay. Several serial photos will demonstrate rapid healing. The patient's nose was fully epithelized one month post-operatively with much-improved contour and shape. Primary excision of nodular cystic lesions followed by LP can help restore normal nasal appearance in patients with deforming rhinophyma. Healing via secondary intention with daily dressing changes remains an excellent strategy for patients' status post rhinophyma excision. The photo timeline of this severe rhinophyma case is a valuable tool when counseling future patients who are apprehensive about undergoing surgical intervention.