• Temporary erythema: patients complain that, either suddenly, or as an effect of a precipitating factor, such as increased environmental temperature, consumption of alcohol or seasonings, and most importantly, mental stress, they develop temporary erythema (reddening) mostly on the face, neck, or chest.
• Permanent erythema: the reddening is now permanent on the face, while small vessels begin to appear on the skin surface, especially on the sides of the nose and the cheeks. The reddening becomes more intense as an effect of precipitating factors.
• Papulovesicles: in addition to erythema, red spots (papules) also appear on the skin, some of which also have pus (vesicles). Although the appearance resembles common adolescent acne, the key characteristic of the latter is absent, which is comedones (little black spots-open comedones) or whitish protuberances (closed comedones).
• At the last stage, which is fortunately rare, in addition to the previous characteristics, severe sebaceous gland hyperplasia occurs, along with connective tissue overgrowth, resulting in skin thickening and facial deformity. Depending on the location of the lesion, it is identified as rhinophyma (on the nose), metophyma, otophyma, and gnatophyma.
Although the etiology is actually unknown, various possible factors have been blamed, such as:
• Gastrointestinal disorders
• Microorganism activity
• Vascular disorders
• Abnormality of the hair-sebaceous unit
• Damage in the underlying tissues
• Genetic predisposition
• Combination of genetic predisposition and exposure to the sun
• Medication that causes vasodilation.
Treatment options depend on the stage and severity of the disease.
At early stages, topical application of vasoconstrictive cosmetic preparations is recommended, of plant origin in many cases. At more advanced stages, it is required to use topical proprietary medicines that mostly contain metronidazole or azelaic acid. In advanced stages (papulovesicular), it is required to administer drugs orally, either antibiotics (tetracyclines) or vitamin A derivatives (isotretinoin) at low doses. At the last stage of rhinophyma, a surgical operation on the skin is required, by cauterizing the lesions with diathermy or laser.