Rinofima is an opukholevidny good-quality change of skin of a nose which is shown by a hypertrophy of all elements of a nose that disfigures a human face. As all elements of skin increase, the size and width of channels of sebaceous glands are hypertrophied too. At a rinofima the strengthened salootdeleniye is noted, fat accumulates in channels, decays owing to what there is an unpleasant smell. For diagnosis of "rinofim" of usually rather simple dermatological survey. Results of the cytologic research separated mouths of hypertrophied sebaceous glands allow to specify the diagnosis.
Rinofima is an opukholevidny good-quality change of skin of a nose which is shown by a hypertrophy of all elements of a nose that disfigures a human face. As all elements of skin increase, the size and width of channels of sebaceous glands are hypertrophied too. At a rinofima the strengthened salootdeleniye is noted, fat accumulates in channels, decays owing to what there is an unpleasant smell.
Reasons and mechanism of development of a rinofima
Rinofima is an infiltrative and productive complication of a rozatse and is more often diagnosed for men is more senior than forty years. If in the anamnesis of the patient of rinofimy there is no rozatse or pink eels then it is considered as a separate disease. The disease etiology is up to the end not studied, but to fluctuations of temperatures similar pathologies diagnose for people who are subject to a frequent overheat and overcooling, more often; the increased humidity or excessive dryness, and also dust content of air increase risk of emergence of a rinofima too.
Patients rinofimy at the anamnesis usually have endocrine diseases, violations of a hormonal background, a digestive tract disease. Hypovitaminosis, stressful situations and errors in a diet in itself are not the main reason for a rinofima, but in combination with above-mentioned factors increase probability of its emergence.
There is no direct link between rinofimy and chronic alcoholism, but considering that at alcoholism diseases of various bodies and systems join, the excessive use of alcoholic drinks and a rinofim are closely connected among themselves. Congenital vascular changes of face skin and transformation of a congenital vascular nevus at most of patients lead to fimopodobny changes of face skin.
Clinical manifestations of a rinofima
Externally the rinofima looks as an outgrowth, it occurs at the expense of a hypertrophy and a giperplaziya of skin of a nose. The outgrowth can be single or in the form of knots, then the knotty rinofima is diagnosed. Because of expanded vessels color of hypertrophied knots can vary from red to dark brown and lilac shades.
Large sebaceous glands and follicles are corked with a keratin, the area struck with rinofimy represents lymphatic interfollikulyarny inflammatory infiltrate. If the rinofima progresses, then granulomas are observed and often huge sebaceous glands are emptied in a usual sine. At a rinofima it is clearly visible that the most part of hypertrophied fabric consists of expanded vessels with thin walls. The skin affected with rinofimy is more subject to development of new growths.
Rinofima meets several versions. Grandulyarny forms diagnose more often, growths of skin of a nose in this case externally look as rough knots. The consistence of knots soft, and the surface of the site struck rinofimy glossy grease with cyanotic and is more rare a lilac shade.
The fibrous form of a rinofima meets less often, at such form skin layers are also hypertrophied, but skin dense that keeps a nose configuration. A surface smooth, brilliant of enlarged pores release of skin fat which at interaction with air gets an unpleasant smell is possible. At a palpation the expressed giperplaziya of sebaceous glands of various density is felt.
The Fibroangiomatozny rinofima is clinically similar to a fibrous form of a rinofima, but at a palpation knots more elastic and soft. At the expense of a large number of teleangioektaziya the surface of a nose has dark red coloring. Differentiate this form of a rinofima from the others on existence of a large number superficial and deep . Contents bloody and purulent which in process of evacuation shrinks in crusts. Patients besides the complicated breath show complaints to an itch, morbidity and parasteziya.
The Aktinichesky form of a rinofima has more good-quality current, layers terms are thickened evenly and slightly, the nose gets cyanotic coloring, teleangioektaziya are localized mainly on nose wings. At this form of a rinofima of a pustula are absent, and mouths of sebaceous glands are expanded slightly owing to what skin fat separates moderately without formation of crusts on the surface of a nose. The main pathogenetic component of an aktinichesky rinofima is aktinicheskiya .
Current of a rinofima long, with series of stages of a zatikhaniye of process and stages of active growth. As a rule, the active growth of a rinofima is observed in the first years of a disease, in several years growth can stop completely, but the return development of a rinofima is not observed. Rinofima complicates nasal breath, and at the huge sizes and meal in spite of the fact that pathological process does not affect cartilages, pressure from the expanded rinofima upon them is so big that nasal cartilages are deformed or exposed to full destruction.
Diagnostics and differential diagnostics of a rinofima
The dermatologist usually puts the diagnosis of Rinofim on the basis of visual survey, history of development of a disease and the anamnesis of life of the patient. When pressing from deeply involved mouths the white pastelike secret is allocated. Results of the cytologic research separated allow to make precisely the diagnosis, at microscopy epitelialny cages in a large number, skin fat, saprofitny microflora are found, pathogenic microflora can be present not always, existence of pincers like is observed not always too.
Despite bright and specific clinical manifestations of a rinofima, it needs to be differentiated with demodekozy as the rinofima can become complicated demodekozy, but the last is not the main pathogenetic mechanism; skin T-cellular lymphoma, and lymphatic leukemias can be shown by growths of skin tissue of nose too. Additional inspections, such as a biopsy of fabrics, with the subsequent histologic analysis help to exclude, or to confirm the diagnosis of Rinofim
Treatment of a rinofima
Therapeutic methods of a rinofima do not bring results, and therefore various methods of surgical treatment are used. Dermabraziya of the site struck rinofimy skin yields good results at insignificant growths of fabrics and in initial stages of a disease. Hypodermic excision of the expanded fabrics and wedge-shaped excision of the sites struck rinofimy with imposing of intracutaneous seams are shown at deep damages of skin of a nose and at impossibility of application of other techniques of surgical treatment of a rinofima.
Laser therapy of a rinofima in the course of treatment allows to model the disfigured shapes of a nose, that is is reached therapeutic and esthetic effects. If rinofimy struck the insignificant site, then removal by the laser expanded terms is shown. Process of an epitelization occurs in 7-10 days after the procedure. The radio wave method in treatment of a rinofima allows to eliminate quickly and effectively all clinical manifestations and to get into condition a nose. At such treatment there is practically no blood loss, there are no hypostases, the probability of postoperative complications is minimum, and process of rehabilitation is short.
Sometimes, at layer-by-layer excisions of a rinofima patients need plasticity of a nose to restore its form and to achieve esthetic appearance. But a main issue in therapy is partial removal of externally not changed fabrics to reduce probability of a recurrence of a rinofima. At correctly performed operation a recurrence arises only at several percent of patients.
Prevention of a rinofima
There is no specific prevention of a rinofima, but timely treatment of pink eels and a rozatse reduce risk of emergence of a rinofima. After surgical treatment of a rinofima patients should avoid sharp differences of temperatures, to reconsider a diet and if it is required, then to replace the place of work.