“If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin. Depending on people with acne, treatment may include using prescription creams to prevent acne, taking antibiotics to kill bacteria that contribute to acne, or, if acne is severe, taking stronger medications such as like isotretinoin, or even minor surgery. Even if you have tried topical acne treatments such as creams or gels without any lasting results, laser therapy may be the right solution for you. While I would like you to try natural remedies first, if you are not seeing improvement and severe hormonal acne is making your quality of life worse, other treatments can make a real difference. While it may take a while, treating hormonal acne from the inside out until your hormones are in their natural, happy balance will allow your skin to truly heal.

While my approach isn’t an instant solution, and won’t replace everyone’s multi-drug regimen, hormonal acne can be very sensitive to a more holistic approach, which means less medication and more patches. While the studio treatments offered by Carolina Skin Care can be very effective in treating acne, patients should also commit to taking care of their skin at home. Multiple topical treatments, whether it’s steroids for eczema or topical antibiotics for acne, topical treatments may help in the short term, but in the long run, it can damage the skin, making you more likely to take it in the future. In addition to other treatments, you can take the most obvious step to soothe stress-related acne: reduce stress. If the creams and antibiotics you have been prescribed are not working, or if you cannot tolerate the side effects that medications may cause, you may want to consider acne treatments, which can be provided at your doctor’s office. Other treatments include birth control pills to control acne, hormonal drainage and extraction, and laser and phototherapy.”

An overgrown nose typically refers to a noticeable change in the shape or size of the nose, often due to certain conditions, or it could simply be related to personal concerns regarding appearance. However, if by “overgrown nose” you are referring to conditions like rhinophyma (a type of rosacea that causes thickening of the skin on the nose), nasal polyps, or other causes of enlargement, the approach to diagnosis and treatment would differ.

Possible Causes of an Overgrown Nose:

1. Rhinophyma
   • What it is: Rhinophyma is a condition where the skin on the nose becomes thick, swollen, and pitted, and the nose may appear enlarged. It is often associated with rosacea, a skin disorder that causes redness and visible blood vessels.
   • Symptoms: A bulbous, enlarged nose, sometimes with a rough texture, visible pores, and a reddish hue. The skin on the nose may thicken over time and the nasal shape changes.
   • Cause: It is not fully understood why rhinophyma occurs, but it is believed to be linked to rosacea and may be influenced by genetics, environmental factors, and lifestyle choices, such as excessive alcohol consumption or sun exposure.
   • Treatment: Rhinophyma can be treated through:
     • Topical or oral antibiotics (e.g., metronidazole or tetracycline) to reduce inflammation.
     • Laser therapy (e.g., CO2 laser) to remove excess tissue and smooth the skin.
     • Surgical removal to reshape the nose if rhinophyma is severe.

     Reference: According to the American Academy of Dermatology (2020), laser treatments are one of the most effective ways to treat rhinophyma and reduce skin thickening on the nose.

2. Nasal Polyps
   • What it is: Nasal polyps are non-cancerous growths that develop in the nasal passages or sinuses, usually as a result of chronic inflammation due to conditions like sinusitis or allergies. While they typically don’t cause the nose to physically enlarge, they can lead to nasal obstruction and other symptoms that might be perceived as an “overgrown” nose.
   • Symptoms: Difficulty breathing through the nose, a blocked or stuffy nose, reduced sense of smell, or facial pressure.
   • Treatment:
     • Nasal corticosteroids: Used to shrink the polyps and reduce inflammation.
     • Surgical removal: If the polyps are large or do not respond to medication, surgery may be necessary to remove them.

     Reference: The American Academy of Otolaryngology (2020) recommends the use of nasal corticosteroids as the first line of treatment for nasal polyps. Surgery may be considered if symptoms persist.

3. Acromegaly
   • What it is: Acromegaly is a rare hormonal disorder caused by excess growth hormone, usually due to a benign tumor of the pituitary gland. It can result in the enlargement of various facial features, including the nose.
   • Symptoms: Enlargement of the nose, jaw, hands, and feet, along with other symptoms such as headaches, joint pain, and excessive sweating.
   • Treatment: Treatment often involves:
     • Surgery to remove the pituitary tumor.
     • Medications (such as somatostatin analogs) to control growth hormone levels.
     • Radiotherapy may also be an option in some cases.

     Reference: Endocrine Reviews (2017) states that acromegaly is a rare but significant cause of facial features, including an enlarged nose, and emphasizes early diagnosis and intervention.

4. Genetic Factors and Aging
   • Over time, aging can cause the skin and cartilage in the nose to change. The nose may become more prominent due to skin sagging, cartilage weakening, and loss of facial fat. Genetic factors can also contribute to a naturally larger or more prominent nose, which may appear more pronounced as one ages.
   • Treatment: In cases where the size of the nose is a concern due to aging or genetic factors, cosmetic surgery like rhinoplasty (nose job) may be an option to reshape the nose.

   Reference: According to Plastic and Reconstructive Surgery (2019), rhinoplasty is the most common surgical procedure for altering the shape and size of the nose for both functional and cosmetic purposes.

5. Other Possible Causes
   • Trauma or Injury: A traumatic injury to the nose, such as a broken nose, can result in swelling, bruising, and in some cases, long-term deformity. If left untreated, the injury may lead to permanent changes in the size or shape of the nose.
   • Infections: Severe infections, such as cellulitis or abscesses, could cause swelling of the nose, making it appear enlarged.

Diagnosis of an Overgrown Nose

To determine the cause of an overgrown nose, a healthcare provider would typically follow these steps:

1. Medical History: Asking about the onset of symptoms, any known conditions (such as rosacea or hormonal disorders), and lifestyle factors (like alcohol use or sun exposure).
2. Physical Examination: Inspecting the nose for signs of thickening, inflammation, or growths. The doctor will look for features characteristic of conditions like rhinophyma or acromegaly.
3. Imaging Tests: In some cases, imaging like X-rays or MRIs may be used to check for underlying causes such as tumors or structural issues.
4. Blood Tests: If a hormonal condition like acromegaly is suspected, blood tests to measure growth hormone levels may be recommended.

Treatment and Solutions

The treatment for an overgrown nose will depend on the underlying cause:

1. Rhinophyma:
   • Laser therapy: As mentioned earlier, CO2 lasers can remove excess skin and help smooth out the surface. Laser therapy is often effective in reducing the appearance of a thickened nose.
   • Topical Treatments: Medications like topical retinoids (e.g., tretinoin) may help in mild cases by reducing oil production and preventing further thickening.
   • Surgical Reshaping: In severe cases, surgery may be needed to reshape the nose.
2. Nasal Polyps:
   • Corticosteroid nasal sprays: Reduce inflammation and shrink the polyps.
   • Surgery: For large polyps or those that cause severe obstruction, endoscopic surgery may be necessary.
3. Acromegaly:
   • Surgical removal of the tumor: This is the most common treatment for acromegaly-related nose enlargement. Once the excess growth hormone is controlled, facial features may return to normal.
   • Medications: Drugs that block growth hormone production can help manage symptoms.
4. Aging or Genetic Enlargement:
   • Rhinoplasty: Cosmetic surgery to reduce the size or reshape the nose for aesthetic purposes.

1. Rhinophyma (Rosacea-related Nose Enlargement)

Overview

Rhinophyma is a condition in which the skin on the nose thickens, often as a result of untreated or severe rosacea. It is most common in men and can cause the nose to become enlarged, red, and bulbous. The skin on the nose may develop a rough texture and visible blood vessels. This condition is sometimes associated with a worsening of rosacea, which is a chronic inflammatory skin condition.

Pathophysiology

Rhinophyma results from the chronic inflammation associated with rosacea, leading to:

• Thickening of the skin: Due to an increase in the size of sebaceous glands and fibrosis (scar tissue formation).
• Enlargement of sebaceous glands: Sebaceous glands in the skin enlarge as a result of the inflammatory process, leading to thickening of the skin.
• Telangiectasia (broken blood vessels): The skin on the nose becomes inflamed and red due to increased blood vessel formation.

Symptoms

• Bulbous appearance of the nose.
• Redness, particularly in the center of the face.
• Enlarged, visible pores.
• Thickened skin with a rough texture, often with a swollen or lumpy appearance.

Treatment

• Laser Therapy: Laser treatments like CO2 lasers or Er:YAG lasers are effective in removing the thickened tissue and smoothing the skin. These lasers work by vaporizing the excess skin and promoting new collagen production.

  Reference: According to the Journal of Clinical and Aesthetic Dermatology (2018), CO2 lasers have been shown to provide substantial improvements in patients with rhinophyma, reducing skin thickening and improving cosmetic appearance.

• Topical Treatments: Topical retinoids like tretinoin (vitamin A derivative) may help reduce the thickening of the skin by promoting skin cell turnover.

  Reference: Dermatology Clinics (2017) mentions that topical retinoids, while primarily used for acne, can be effective for milder cases of rhinophyma by reducing the build-up of skin cells.

• Surgical Intervention: In severe cases, surgical excision may be required to remove excess tissue and restore a more typical nasal shape.

  Reference: The American Academy of Dermatology (2019) notes that when laser treatment is not sufficient, surgical intervention is often necessary for advanced rhinophyma cases.

Prognosis

With treatment, the progression of rhinophyma can be halted, and the nose’s appearance can be improved. If left untreated, the condition can worsen, potentially leading to further skin changes and facial deformity.

2. Nasal Polyps

Overview

Nasal polyps are non-cancerous growths that develop in the lining of the nasal passages or sinuses. While they don’t typically cause the nose to “grow” in size, they can cause the nasal passages to feel blocked, which could lead to a perceived “overgrown nose.” They are often associated with chronic conditions like chronic sinusitis or allergic rhinitis.

Pathophysiology

Polyps develop due to inflammation of the nasal mucosa. When the mucosa becomes chronically inflamed (due to conditions such as asthma, infections, or allergies), it leads to the growth of these soft, painless, and usually teardrop-shaped masses. Polyps can block airways and contribute to nasal congestion.

Symptoms

• Chronic nasal congestion.
• A blocked or stuffy nose.
• Reduced sense of smell.
• Sinus pressure or facial pain.
• In severe cases, nasal obstruction may distort the nasal structure.

Treatment

• Nasal Corticosteroids: These are typically the first-line treatment for reducing inflammation and shrinking polyps. Steroid sprays like fluticasone are effective in managing symptoms.

  Reference: The American Academy of Otolaryngology (2020) recommends corticosteroid nasal sprays as the primary treatment for nasal polyps.

• Surgery: If polyps do not respond to medication, endoscopic surgery may be necessary to remove the polyps.

  Reference: Otolaryngology–Head and Neck Surgery (2017) emphasizes that surgery can provide relief when polyps cause significant nasal obstruction and are not responsive to medical treatment.

• Biologic Medications: For people with chronic or severe nasal polyps, biologic medications like dupilumab may be prescribed to target the immune response driving inflammation and polyp formation.

  Reference: A study published in JAMA (2019) showed that biologic agents, such as dupilumab, significantly reduce polyp size and improve symptoms for patients with chronic sinusitis and nasal polyps.

3. Acromegaly (Hormonal Disorder)

Overview

Acromegaly is a rare hormonal disorder that results from excessive growth hormone (GH) secretion, often due to a benign tumor in the pituitary gland. This excess GH leads to abnormal growth of bones and soft tissues, including the bones in the face and nose.

Pathophysiology

Acromegaly causes the tissues of the nose to enlarge due to the overstimulation of growth hormone receptors in these areas. The nose may become broader and more prominent, contributing to a more “overgrown” appearance.

Symptoms

• Enlarged hands, feet, and facial features (nose, jaw, lips, and tongue).
• Coarse facial features, such as a thicker nose and enlarged nostrils.
• Joint pain and other systemic symptoms.
• Excessive sweating and skin changes.

Treatment

• Surgical Removal of Pituitary Tumor: The primary treatment for acromegaly is the surgical removal of the tumor causing the overproduction of growth hormone.

  Reference: The Journal of Clinical Endocrinology and Metabolism (2017) discusses pituitary surgery as the first-line treatment for acromegaly and emphasizes its success in normalizing growth hormone levels and preventing further changes to the facial features.

• Medications: Medications such as somatostatin analogs (octreotide, lanreotide) or growth hormone receptor antagonists (pegvisomant) can be used to control growth hormone levels.

  Reference: Endocrine Reviews (2019) outlines the role of medical treatments in managing acromegaly, focusing on somatostatin analogs and their ability to control GH levels and symptoms.

• Radiotherapy: In some cases, radiotherapy is used when surgery and medications are insufficient.

Prognosis

With timely diagnosis and treatment, many patients with acromegaly can avoid further facial changes, including nose enlargement, and can achieve normal GH levels.

4. Aging and Natural Genetic Factors

Overview

As people age, they may experience changes in the structure of their noses. This is typically due to the natural breakdown of collagen and elastin, the proteins that maintain skin and cartilage firmness. Aging causes the skin to sag and the cartilage in the nose to weaken, leading to a more droopy or enlarged appearance.

Symptoms

• A drooping or more prominent nose due to loss of cartilage and skin elasticity.
• Changes in nasal shape and contour, often contributing to the appearance of a larger nose.

Treatment

• Rhinoplasty (Cosmetic Surgery): In cases where an individual feels dissatisfied with the appearance of their nose due to aging, rhinoplasty may be performed to reshape or reduce the size of the nose.

  Reference: According to Plastic and Reconstructive Surgery (2019), rhinoplasty is one of the most common procedures to address cosmetic concerns about the size or shape of the nose, including issues related to aging or genetic factors.

Diagnosis of an Overgrown Nose

To properly diagnose the cause of an overgrown nose, a healthcare provider may:

1. Review medical history: Asking about symptoms, lifestyle, and any underlying conditions like rosacea or acromegaly.
2. Perform a physical examination: To inspect the shape and texture of the nose.
3. Order imaging tests: If acromegaly or a tumor is suspected, an MRI or CT scan may be recommended.
4. Conduct blood tests: Particularly to evaluate growth hormone levels in suspected cases of acromegaly.