The clinicopathologic spectrum of rhinophyma

We report the results of a clinicopathologic study of 17 patients with rhin ophyma in different stages of evolution, with particular attention paid to the severe form of this disease. On the basis of clinical features, we iden tified 2 groups of patients: the first group (12/17 patients) included pati ents with the common form of rhinophyma, whereas the second one (5/17 patie nts) included patients with the severe form of the disease. There was no li nk between the clinical aspect and the duration of the disease. Microscopic examination of specimens obtained from the classic type of rhinophyma subs tantially showed the histopathologic features of fully developed rosacea, e xcept for the presence of prominent sebaceous hyperplasia. The second group showed a very different histologic pattern displaying marked dermal thickn ess, absence of folliculosebaceous structures, sclerotic collagen bundles w ith large amounts of mucin, and spreading telangiectasia. The inflammatory infiltrate was inconspicuous, with numerous interstitial spindle and bizarr e cells. Most of the interstitial cells were reactive to factor XIIIa. The severe form of rhinophyma shares many histologic characteristics with eleph antiasis caused by chronic lymphedema.