Treating Rosacea: What to Do About Thickening Skin

When most people think of rosacea, they likely think of reddened skin and visible blood vessels. However, other types of rosacea may cause different symptoms, such as thickening skin, or phyma. This thickened, swollen skin is caused by a type of rosacea known as phymatous rosacea.

“Phymatous rosacea is really the enlargement of the sebaceous glands,” says Michelle Henry, MD, dermatologist in New York City and clinical instructor at Weill Cornell Medical College. These are the glands that secrete sebum oil to hydrate your skin and hair.

Like many symptoms of rosacea, this enlargement of the sebaceous glands is linked to inflammation. After years of chronic inflammation in the skin, the sebaceous glands swell, causing the skin to have a thickened appearance. Most commonly, phyma occurs on the nose, which is called rhinophyma.

“Initially, patients will start to see little lumps and bumps, smaller areas of thickening,” says Dr. Henry. “With time, it will become larger and larger, and then ultimately, you’ll have that kind of classic bulbous nose … so it is a gradual process.” In severe cases, the nose may become so swollen that it obstructs breathing through the nose.

The best way to treat phyma (which comes from the Latin word for “swelling”) is to prevent it altogether. By treating rosacea symptoms and making lifestyle changes to reduce rosacea flares, you can minimize inflammation and reduce the risk of developing phyma. Treatment may also include oral and topical medications.

Treating already thickened skin is a bit more difficult. “Once you have that thick phymatous tissue, you really have to get rid of it surgically,” says Dr. Henry.

There are a few different approaches to surgically remove phyma. Traditionally, a surgeon would just reshape the nose with a standard scalpal. However, newer options aim to reshape the nose with less pain and bleeding, using techniques like high-frequency electric currents, loop cautery (a loop-shaped wire), dermabrasion, and laser therapy. These various methods help break down or shave down the thickened skin and reshape the nose to its previous appearance.

Again, treating your rosacea early can help prevent phyma—and the need for surgery. “Make sure that you see a professional, to make sure that you’re having the appropriate treatments for your level of severity.”

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