What is Alcoholic Nose or Rhinophyma?

If you’ve ever heard someone refer to a person’s nose as an “alcoholic nose” or “drinker’s nose,” they were likely talking about a skin condition called rhinophyma that can make the nose and face look red and bumpy. It often looks worse during a period of heavy drinking or when someone chronically uses alcohol.

While heavy consumption of alcohol can make the skin look worse, rhinophyma is actually a side effect of rosacea, which is a common skin condition affecting approximately 5% of the global population, according to the National Rosacea Society. Recreational drinking and/or alcohol use disorder aren’t direct causes of “drinker’s nose.”

Rhinophyma is relatively rare and very treatable. People living with this condition have several options, including lifestyle changes, to help them decrease symptoms and feel more confident about their appearance.

Rhinophyma is a skin disorder that’s a subtype of rosacea. It only affects the skin tissues and blood vessels and doesn’t change any underlying structures, such as cartilage or bone. With rhinophyma, the nose appears swollen, red and bulbous.

It’s most common in older white males over 50 with a family history of rosacea or rhinophyma and fair-toned skin. Rhinophyma is divided into four types: actinic, fibrous, fibroangiomatous and glandular. The type someone has depends on the cause of the overgrowth and the tissues affected. Rhinophyma is considered a progressive, chronic skin condition, meaning that skin changes generally worsen over time.

The exact cause of rhinophyma is unknown beyond the fact that it’s related to rosacea, and it can happen to both drinkers and non-drinkers. However, the symptoms are more likely to increase in severity when someone consumes alcohol regularly.

While alcoholism doesn’t directly cause rhinophyma, alcohol does have the potential to worsen any existing skin condition that a person has, including rosacea. Rosacea is an inflammatory skin disease that’s affected by alcohol use, causing facial redness, flushing and visible blood vessels.

Alcohol is a vasodilator, which means it causes blood vessels to dilate and blood to flow to the skin’s surface. This effect is especially noticeable on a person’s face or on those with a fairer skin tone. In people who already have rosacea and rhinophyma, this can lead to increased inflammation, flushing and further progression of these conditions. 

Dealing with rhinophyma can be challenging. Low self-esteem and isolation due to avoiding social situations are common in those who’ve been diagnosed. These psychological side effects can lead to further mental health issues, such as depression or anxiety, which may increase the risk of substance use.

Doctors diagnose rhinophyma through a visual exam. While moderate to advanced cases of rhinophyma are easy to recognize, those in earlier stages may not be as obvious. The signs and symptoms of rhinophyma can include:

• Red and bumpy skin on or around the nose (called “gin blossoms”)
• A bulbous nose
• Broken blood vessels
• Thickening of the skin on the face
• Oily skin
• Enlarged pores
• Flushed appearance
• Swollen appearance

In rare instances, a doctor may perform a biopsy, but this is typically done only when the rhinophyma hasn’t responded to treatment and other conditions need to be ruled out.

Rhinophyma can be harder to recognize and diagnose on darker skin. Dermatologists may look for other signs, such as difficulty breathing through the nose and facial pain, rather than the more typical signs of redness and visible blood vessels.

While there’s no cure for rhinophyma or rosacea, there are treatments that can help reduce symptoms and improve appearance. Visiting your primary care physician is a good first step, but treating rhinophyma usually requires seeing a dermatologist.

Lifestyle Changes and Prevention

Certain lifestyle changes can improve the symptoms of rhinophyma and make the condition easier to manage. These changes include avoiding triggers, maintaining a healthy lifestyle and seeking help for mental or behavioral health problems that arise.

One of the biggest lifestyle changes that can prevent rhinophyma or improve its symptoms is to stop drinking alcohol. In some cases, this may require professional intervention and help in the form of drug and alcohol rehab.

Addiction treatment for alcohol use disorder may include:

• Medical detox
• Medication-assisted treatment (MAT)
• Inpatient treatment
• Outpatient treatment
• Behavioral therapy for addiction
• Sober living homes
• 12-step and non-12-step programs
• Aftercare

When considering treatment programs for substance use, look for an addiction recovery program that’s accredited and in-network with your healthcare insurance.

Prescription Medications

Certain medications may help treat rhinophyma if lifestyle changes aren’t enough or the condition is more advanced. Isotretinoin is an oral retinoid medication that helps shrink sebaceous glands and slow facial oil production. Because inflammation of the sebaceous glands is part of rhinophyma, it can help slow down the physical changes.

Metronidazole is another option, but it’s used to reduce the overall skin inflammation characteristic of rosacea and isn’t for rhinophyma specifically. It’s a topical cream that’s applied to the nose and surrounding area and may reduce swelling and redness. Your doctor may prescribe both of these medications together to help control your symptoms.

Surgical Treatments

Advanced rhinophyma may require surgical treatment to remove the affected tissues and restore a more natural appearance to the nose. Both dermatologists and plastic surgeons are generally involved in determining if you’re a candidate.

Surgical treatments for rhinophyma include:

• Dermabrasion. This procedure uses a special tool to remove the top layer of the skin, improving the overall texture and feel of the skin.
• Dermaplaning. This deep exfoliation technique can be performed with or without chemicals and removes small amounts of raised tissue without surgery. 
• Debulking. In this surgical procedure, a plastic surgeon uses specialized scissors to remove the raised tissue and thickened skin.
• Electrocautery. Your doctor will remove excess skin tissue on the nose using a special tool with a heated tip. It can be used as a stand-alone treatment or combined with other surgeries.
• Laser therapy. This procedure, which uses lasers rather than surgical instruments, can further contour the nose and seal other tissue removal sites.

One of the biggest warning signs for alcohol abuse is feeling like your drinking habits are out of control or like you can’t cut down or quit. Experiencing withdrawal symptoms when you don’t drink, having financial or relationship difficulties due to drinking and hiding your alcohol use are also signs of alcohol use disorder.

If you or a loved one is living with rhinophyma, know that you’re not alone and that you can start to feel better and heal from this condition. Having your skin evaluated by a dermatologist or other experienced healthcare provider can help you better understand the condition and learn more about the treatment options. 

If you’re concerned that alcohol could be making rhinophyma worse or you think you may have a drinking problem, reaching out to an alcohol treatment center can be a good first step. Contact RehabNet.com today on our free, confidential helpline to find out more about how you can start your recovery journey right away.