Treatment of Rhinophyma with Exclusive Diathermic Electrocautery and Secondary Intention Healing: A Case Report

Abstract

Background: Rhinophyma is an advanced manifestation of rosacea characterised by progressive hypertrophy of nasal skin and pilosebaceous structures. In severe cases, it can cause marked disfigurement and psychosocial distress, with or without airway obstruction. This report describes tangential excision performed exclusively with a diathermic loop, followed by secondary-intention healing. Case Presentation: A 75-year-old man with diabetes and a history of acne rosacea presented with a progressively enlarging, bulbous nasal deformity of 12 years' duration. Examination showed irregular soft-tissue hypertrophy involving the nasal tip and adjacent nasal structures, without ulceration, bleeding, or nasal airway obstruction. Under general anaesthesia, the affected tissue was excised sequentially using a diathermic loop. The excision extended to the reticular dermis, with care taken to preserve the deeper pilosebaceous structures and avoid exposure of cartilage and bone. The technique permitted tissue removal, nasal contouring, and haemostasis during the same procedure. Postoperative care initially involved povidone-iodine gauze, followed by petrolatum gauze and topical 2% fusidic acid, with scheduled dressing changes. Outcome: Complete wound healing was documented within 25 days, without reported infection, delayed healing, or tissue necrosis. The short-term postoperative assessment showed a satisfactory nasal contour. Conclusion: This case documents the feasibility of diathermic-loop tangential excision with secondary-intention healing for severe rhinophyma. The single-patient outcome cannot establish comparative effectiveness or long-term recurrence risk.