Photo Rounds Friday Archive

Bumps on nose

Post Date: 8/14/09

Click to see full size image

A 51-year-old Hispanic man came into the office because he was disturbed by the appearance of his nose. He denied any pain or itching of the nose. He was particularly upset that children had been pointing at his nose and appeared to be making fun of him. He acknowledged a history of heavy drinking in the past, but had stopped drinking alcohol completely.

What's your diagnosis?

We diagnosed rhinophymatous rosacea causing hypertrophy of the sebaceous glands of the nose. In this case, the patient did not have other stigmata of rosacea such as erythema and telangiectasias on the cheeks. While this is often called a “W.C. Field's nose,” it is not necessarily related to heavy alcohol use.

We started the patient on oral tetracycline 500 mg PO bid and topical metronidazole gel 1% bid. The patient noted some improvement in the redness of his nose, but the enlarged appearance still bothered him. We discussed radiofrequency electrosurgery and he chose to go ahead with this treatment.

His nose was anesthetized with 1% lidocaine and epinephrine and an electrosurgical loop was used to pare down the hyperplastic sebaceous glands and skin. The patient tolerated the procedure well. He then applied petrolatum to the healing nose twice daily. The patient was pleased with the outcome.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Rosacea. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:447-452.

To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
* http://www.mhprofessional.com/product.php?isbn=0071474641