yes!

but don´t forget isotretinoin 20 mg for maybe 3 or 4 months.

after that,   I use to do LASER sessions ( yag laser GENESIS CUTERA ) with great results

regards!

Thank you sir.

What are the criteria followed  in the diagnosis of rhinophyma in the present case , 23 old woman. Zygomysis (Rhinoentomoththoramycossis) is often misdiagnosed as rhinophyma. During the period between 1984 and 95, we investigated 9 cases of zygomycosis. Prior to our investigation the cases attended  Dermatology and ENT clinics in and around Calcutta, where they were diagnosed as rhinophyma or some other disease; and received improper treatment including surgery.  The disease neither arrested nor cured resulting in considerable morbidity.  Mycological examination of nasal  mucosa  resulted in the detection of Conidiobolus coronatus in tissues and isoation of the causal agent in culture.  The patients were cured either with KI  alone or fluconazole.

What is the differential diagnosis of rhinophyma in the 23 year old woman?  A file picture of the case will help in understanding the disease. Exclude fungal infection in the case. 

sarcoidosis, acne vulgaris, LECD and maybe if erysipela affecting the nose may sometimes mimic rosacea, not in general but is specific cases

refering Dr Anisetti cases, we dermatology clinicians are facing more and more with missdiagnosis of skin diseases. In my opinion this is due to the interference of cosmiatric procedures and its economic reward so, the young dermatologists lack interest in tradicional dermatologic diseases. Do you agree?

I published this papaer of cases of misdiagnosis of tinea faciei as rosacea  , hope you find it interesting:

https://www.academia.edu/20110050/Rosacea-like_Tinea_Faciei

Medical errors in fungal diseases are every where. This is due to neglect of fungal diseases.  Health care professional are not trained in medical mycology. The cases I presented received improper treatment  else where. A noted ENT surgeon treated the first case twice performing butterfly incision and debridation.  He acted on the basis of histopathology report but not on own his discretion. During the period between 1965 and 1995, we encountered so many unfortunate cases who are victims of medical errors. Actinomycetoma cases which are eminable to treatment often treated with amputation.  Recently, while treating psoriasis with Wrightia tinctoria extract, we encountered  tinea corporis cases receiving treatment for psoriasis. Due to technical problems the amputed cases can not be presented. Below is tinea corporis case who received treatment for psoriasis.

Yes, unfortunatelly this is really a problem. I also see patients with Pseudo.psoriasis treated with corticosteroids which turns the tinea to  giant proprotions. Yes again: I live in a 2 million people city and we have just 2 reliable laboratories for mycological exams.

Yes sir. mycological examination is not done as a routine. Dermascopic examination is to be done as a routine clinical examination and the clinician whether young or old has to consider the importanc of clinical diagnosis rather than financial rewards.

I wonder if this young girl is otherwise healthy because rynophima is a more old-aged disease

regards

she is healthy

Dear Venkata, Rhinophyma and other phymas are localized swellings of facial soft tissues due to variable combinations of fibrosis, sebaceous hyperplasia and lymphoedema. They develop almost entirely in males. The commonest is rhinophyma, a swelling of the nose which may become grossly distorted in contour. Other areas which may be affected include the forehead (metophyma), chin (gnathophyma), eyelids (blepharophyma) and ears (otophyma). In many cases rhinophyma develops in patients with a long

history of other features of rosacea, and it is often regarded as a complication or ‘end stage’ of the disease. However, rhinophyma is sometimes also seen in patients who do not have any history of other manifestations of rosacea. Occasionally rhinophyma is complicated by the development of a malignancy and this can be difficult to recognize. It is likely, but not proved, that active treatment of

rosacea may inhibit the development of rhinophyma. Unfortunately neither systemic nor topical treatments for rosacea have any useful impact on established rhinophyma. One exception is systemic isotretinoin, which can significantly reduce the bulk of rhinophyma although it does not restore normal skin contours. Treatment of rhinophyma and other phymas therefore usually involves surgical removal of excess tissue or other means of physical ablation. Remodelling can often be successfully achieved simply by paring off the excess tissue with a

scalpel. Electrosurgery is an inexpensive alternative method. Excision and vaporization with argon, carbon dioxide or Nd : Yag lasers is effective. Other treatments have included cryotherapy and ionizing radiation. The latter approach is probably most useful in cases with coexisting malignancy.

quite usefull , Dr Adil. I forgot to say that cryotherapy gives some results thinning the hyperplaic nose tissue

Treatment involves surgical excision with closure/cover depending upon the size_local flap or graft. Also lasers can be tried ad well as chemotherapy.

Primo: exfoliation, after: cryotherapy; after: abrasion; long after: surgical technic