Types of Rosacea: Phymatous Rosacea - Gladskin

Types of Rosacea: Phymatous Rosacea

A rare form of rosacea known as phymatous rosacea doesn’t simply cause red skin — it actually creates excess skin tissue growth that can lead to disfiguration of your facial features through excess tissue build-up.

This form of rosacea is considered the last stage of rosacea and is generally more severe. At-home symptom management won’t be enough to treat phymatous rosacea.

If you or your loved one is suffering from phymatous rosacea symptoms, surgical or laser treatment is likely needed to restore your skin back to a healthy state. 

Phymatous rosacea can be a complicated and confusing skin condition, so let’s jump into what the symptoms are, what causes and what doesn’t cause this rare form of rosacea, plus how to treat it.


Phymatous Rosacea Symptoms

Phymatous rosacea, also known as subtype 3 rosacea, causes excess skin tissue growth that results in thickening skin as well as irregular surface nodularities and enlargement.

This form of rosacea typically affects the nose, but it can also cause symptoms on the ears, chin, forehead, cheeks, and even the eyelids.

Rhinophyma, the development of a red, enlarged, bumpy, and bulbous nose, is the symptom most connected with phymatous rosacea.

Depending on how the nose enlarges and where the nodules form near the nostrils, rhinophyma caused by phymatous rosacea can even lead to difficulty breathing. This is just one of the many reasons why discussing the skin condition with a board-certified dermatologist is crucial.

Unlike most forms of rosacea, with phymatous rosacea the skin can appear red, but it can also appear as the normal skin tone — or even yellow and waxy.

Men are much more at risk of developing phymatous rosacea that leads to rhinophyma.


Phymatous Rosacea’s Effect on Quality of Life

While phymatous rosacea has a direct effect on the health and appearance of the skin, its side effects go much deeper.

Because of the disfiguration this subtype 3 rosacea can cause, the skin condition can have a large negative impact on a person’s mental and emotional health — as well as their ability to comfortably socialize and go out in public.

If you or a loved one is experiencing psychological distress as a result of phymatous rosacea, don’t hesitate to seek help. Talking to a licensed therapist or counselor can help you work through the emotional difficulties associated with subtype 3 rosacea.

Though this form of rosacea is uncommon, you are not alone in what you’re dealing with. You can even find online support groups for people who are going through a similar experience and can better relate to your skin struggles.


What Causes Phymatous Rosacea?

Like with other forms of rosacea, the exact cause of phymatous rosacea remains unknown. However, inflammation is thought to be at the root of the skin condition.

In the case of phymatous rosacea, doctors believe inflammation increases the size of the sebaceous glands and the amount of connective tissue and collagen in the skin.

Unfortunately, many people have wrongly come to believe that alcohol consumption causes rhinophyma. These people have used the names “whiskey nose,” “rum nose,” and “drinker’s nose” to describe the skin condition. However, that’s not the case. 

Sometimes alcohol can trigger symptoms, as it can for other forms of rosacea as well. One observational study of 52 phymatous rosacea sufferers found excessive alcohol consumption may make rosacea worse. There isn’t, though, a cause-and-effect association between alcohol and rhinophyma.

The stigma that someone with rhinophyma is an alcoholic or drinks excessively only further contributes to the negative consequences phymatous rosacea can have on your mental, emotional, and social well-being. 


Phymatous Rosacea Treatment

To find the best treatment plan for your phymatous rosacea, visit your dermatologist or primary healthcare provider (who can refer you to a dermatologist). 

Phymatous rosacea requires more than at-home treatment, so you’ll need to make an appointment to treat your skin symptoms. As always, it’s best to visit your provider sooner rather than later, because slowing the progression of symptoms is much easier than reversing the damage that has already been done.

Your dermatologist may recommend:


Oral Medications

Oral medications aren’t the most effective method of treating phymatous rosacea and rhinophyma. However, if you and your dermatologist have caught the skin condition in its early stages, your doctor may prescribe an oral antibiotic that can help lower inflammation in the body — or a drug called isotretinoin.

Some people have found isotretinoin helpful for the beginning stages of phymatous rosacea, because it can shrink the sebaceous (oil) glands. However, isotretinoin can only prevent phymatous rosacea from worsening. It won’t reverse the damage the skin condition has already caused. 

Another downfall: the medication only works if you’re taking it. Its beneficial effects will stop when you discontinue the use of the medication.

Because these medications can’t reverse pre-existing damage to the skin, surgery is often the best treatment option for phymatous rosacea.



Surgery is thought of as the best treatment option for rhinophyma for long-term success. You and your doctor have multiple options to choose from when it comes to surgery to remove thickened skin. Common surgery types include:

  • Dermabrasion, which uses a rotating tool to remove the top layer of skin... Because this method tends to only be surface level, this technique is typically used in conjunction with other treatment methods.

  • CO2 laser, which has proven to be quite a successful treatment method for severe cases of rhinophyma... Patients tend to respond well to this treatment and have minimal downtime following treatment.
      • Scalpel excision, which involves using a blade to manually remove excess tissue... Typically, the patient will be under local anesthesia for this procedure. Depending on the severity of tissue growth, your doctor may opt for a series of treatments to remove all the excess skin growth.
      • Electrosurgery, which uses a high-frequency current to remove the excess skin and also involves administering local anesthesia... Like with scalpel excision, your doctor may opt for a series of treatments to fully remove excess tissue. Electrosurgery is thought of as one of the most effective treatment modalities.
      • Cryosurgery, which freezes off excess tissue using extremely cold temperatures… This tends to be a quick and simple treatment with little pain for the patient; however, this method gives providers less control over the depth of the skin tissue removal.

      Rosacea-Friendly Skincare

      With phymatous rosacea, it’s best to continue to follow the recommendations for all types of rosacea, including:

      • Wearing a rosacea-friendly sunscreen everyday. Typically, people with rosacea should look for sunscreen made with zinc oxide and/or titanium dioxide and avoid sunscreens with chemicals like oxybenzone, avobenzone, octisalate, octocrylene, homosalate, octinoxate, and fragrances.
      • Using a gentle, hypoallergenic moisturizer. People with rosacea often have very sensitive skin. That’s why choosing a gentle sunscreen and moisturizer can help prevent further aggravation of the skin. Look for a moisturizer without harsh additives like parabens, sulfates, fragrances, alcohol, and preservatives. 

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      Avoiding Triggers

      Rosacea triggers can increase the blood flow to the surface of the skin and worsen rosacea symptoms. That’s why avoiding these triggers may help improve redness. To minimize flare-ups, avoid:

      • Spicy foods
      • Hot drinks
      • Alcohol
      • Caffeine
      • Emotional stress, including anxiety
      • Extreme temperatures (hot or cold)
      • Exposure to sunlight

      Minimizing exposure to these triggers likely won’t impact the size and shape of your rhinophyma, but it can improve the coloration of your skin.



      Phymatous rosacea, though uncommon, has the ability to disfigure your facial features. For that reason, the phymatous rosacea effects can be greater on your quality of life than even on your skin. If you suspect your rosacea may be developing into this form, visit your dermatologist to establish a prevention and/or treatment plan. And always remember, we at Gladskin are here to support you.