The Clinical Spectrum of Phyma: A Case Report of Rhino-Metophyma and Review of the Literature

Abstract

Introduction: Phyma of the nose, or rhinophyma, is considered a diagnostic clinical phenotype of rosacea. Rarely, phyma manifestations may be present on the chin (gnathophyma), ear (otophyma), forehead (metophyma) and eyelids (blepharophyma). The purpose of this paper was to present a case of rhino-metophyma and to review the literature on the topic.

Case presentation: A 74-year-old Caucasian male with a history of inflammatory rosacea, complained of marked nasal and frontal skin thickening. Based on clinical, ultrasound, and histopathological examination, the diagnosis of rhino-metophyma was formulated. A literature review from 2000 to 2024 revealed 14 cases of rhinophyma associated with other localizations: 7 cases of rhino-otophyma, 4 of rhino-gnathophyma, and 3 of rhino-metophyma. Reported cases of isolated extranasal phyma were 21: 10 of gnathophyma, 9 of otophyma, and 2 of metophyma. Overall, patients with involvement of the nose and extranasal phyma were predominantly males with a male:female ratio 6:1, while among extranasal localizations the male:female ratio was 1.1:1.

Conclusion: The diagnosis of rhinophyma is clinical and in the majority of cases quite easy, less for the isolated phymas in extranasal localizations. Little is also known about the management of these forms, and more studies on the prevalence of extranasal localizations and their therapeutic management would be desirable.

Keywords: Case report; Metophyma; Phyma; Rhinophyma; Rosacea.

Fig. 1.

a Clinical picture of the patient presenting rhinophyma (nodules and fibrotic plaques of the nose) and metophyma (large, thickened plaques of the frontal regions). Ultrasound examination of normal scalp skin (b) and thickened phymatous plaque of the left frontal region (c).