AUTHOR QUERY SHEET

AUTHOR QUERY SHEET
Author(s) : Ying-Yi Chiang
Article title :
Moderate rhinophyma successfully treated with a Smoothbeam laser
Article no : 486395
Dear Author,
Please check these proofs carefully. It is the responsibility of the corresponding author to check
against the original manuscript and approve or amend these proofs. A second proof is not
normally provided. Informa Healthcare cannot be held responsible for uncorrected errors, even if
introduced during the composition process. The journal reserves the right to charge for excessive
author alterations, or for changes requested after the proofing stage has concluded.
The following queries have arisen during the editing of your manuscript and are marked in the
margins of the proofs. Unless advised otherwise, submit all corrections using the CATS online
correction form. Once you have added all your corrections, please ensure you press the “Submit
All Corrections” button.
AQ1: Please check that the author names and affiliation have been set correctly.
AQ2: Do you mean: ‘which he had suffered from for 1 year’.

MJDT_A_486395.3d Wednesday, 9th June 2010 09:54:55
Journal of Dermatological Treatment. 2010; 00:000–000
1 LETTER
2 Moderate rhinophyma successfully treated with a Smoothbeam laser
3 CHIA-LUN CHOU & YING-YI CHIANG *
4 Department of Dermatology, Taipei Medical University-Wan Fang Hospital, 111 Hsing-Long Road, Section 3,
5 AQ1 Taipei 116, Taiwan
6 Sirs,
7 Rhinophyma, the end stage of evolving rosacea, is a
8 disfiguring disorder of the nose characterized by an
9 erythematous swollen nose with prominent pilosebac-
10 eous dilated pores and telangiectasia. Rhinophyma
11 occurs much more often in men than in women (with
12 an approximate ratio of 20:1), although rosacea is
13 more common in females (1). Histopathologically,
14 rhinophyma shows prominent sebaceous hyperplasia,
15 dilated infundibula, telangiectasia in the superficial
16 dermis, and perifollicular inflammatory cell infiltra-
17 tion (2). Clinically, marked skin thickening and irreg-
18 ular surface nodularities of the nose cause cosmetic
19 embarrassment and distress for patients. Herein, we
20 describe the successful treatment of moderate rhino-
21 phyma with a 1450-nm diode laser as an effective and
22 safe alternative.
23 An 80-year-old man was diagnosed with phymatous
24 AQ2 rosacea for 1 year. He suffered from several painful
25 erythematous papules and pustules over the glabella,
26 bilateral cheeks, and nose. The patient’s nose showed
27 features of rhinophyma, including persistent ery-
28 thema, telangiectasia, thickening, and irregular
29 surface contours (Figure 1). He had received medical
30 treatment including topical metronidazole and oral
31 doxycycline 100 mg bid for 8 weeks continuously.
32 However, the clinical response was limited. There-
33 fore, we used a 1450-nm diode laser with a cryogen
34 cooling spray (SmoothbeamÔ; Candela Corp.,
35 Wayland, MA, USA) as an alternative treatment.
36 Pretreatment anesthetic cream (5% EMLA) was
37 applied 1 hour before the laser to reduce the patient’s
38 discomfort. The following treatment variables were
used: a spot size of 4 mm, a fluence of 17 J/cm 2 ,a
pulse duration of 210 ms, and a dynamic cooling
device (DCD) spray duration of 28 ms. His nose
was treated with a single non-overlapping pass. Three
treatment sessions spaced 4 weeks apart were given.
We chose the same treatment fluence as a previous
study for treating sebaceous hyperplasia (3). Moreover,
the use of a single non-overlapping pass, a
shorter duration of DCD spray, and delivery of treatments
at 4-week intervals were thought to reduce the
occurrence of post-inflammatory hyperpigmentation,
especially in this Fitzpatrick skin type IV patient (4),
since the duration of the cryogen spray and the length
of the treatment intervals play important roles in
causing hyperpigmentation (5). During the treatment,
he only applied topical metronidazole, and
his condition improved greatly. Only mild telangiectasia
remained (Figure 2). Subjective satisfaction of
both the patient and physician were assessed to exceed
90% improvement, except there was transient pain
during the procedure. No complications such as
hyperpigmentation, blisters, or scarring were noted.
The response of the Smoothbeam laser was maintained
for more than 6 months, even without oral
antibiotics (Figure 3).
For early-stage rhinophyma, oral and topical antibiotics
may reduce the inflammation, while oral
and topical retinoids are beneficial in decreasing the
sebaceous gland size and suppressing sebum secretions
(6). For advanced rhinophyma, a wide range of
effective surgical approaches including cryosurgery,
electrosurgery/electrocautery, dermabrasion, and
scalpel or razor blade excision were advocated.
UNCORRECTED PROOF
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
*Correspondence: Fax: 886 2 8862 1197. E-mail: ellychiang@hotmail.com
(Received 16 December 2009; accepted 14 March 2010)
ISSN 0954-6634 print/ISSN 1471-1753 online Ó 2010 Informa UK Ltd.
DOI: 10.3109/09546634.2010.486395

MJDT_A_486395.3d Wednesday, 9th June 2010 09:54:56
2 C. Chou & Y. Chiang
Figure 1. Rhinophyma before laser treatment. Multiple painful erythematous papulopustules over the nose and nasolabial folds are evident.
Figure 2. After three treatment sessions. The severe erythema with nodularities were greatly improved.
72 Nevertheless, surgical therapies have longer recovery
73 times, and the possible complications may include
74 poor hemostasis, uncontrolled depth of tissue destruc-
75 tion, and cartilaginous necrosis (7). Ablative lasers
76 (carbon dioxide and erbium:yttrium-aluminum-garnet
77 lasers) have been reported to achieve remarkable
hemostasis and cosmesis. However, post-treatment
hypopigmentation and hyperpigmentation are common
in patients with darker skin types (8). Furthermore,
those treatments only improve the appearance
of the rhinophyma rather than reduce the formation
of papulopustules.
The Smoothbeam laser, a 1450-nm diode laser, is
used for treating active acne (4,9), atrophic acne
scarring, sebaceous hyperplasia (3), and periorbital
rhytides (5). This laser emits a wavelength of
1450 nm, which is absorbed by water within the
dermis at 100–600 mm deep, leading to the selective
photothermal destruction of sebaceous glands,
thereby reducing sebum production (9). It improves
the nasal contour resulting from sebaceous hyperplasia,
and also concurrently decreases painful inflammatory
papulopustular eruptions. Compared with
other therapies, there is less pain, no bleeding, and
no downtime.
In summary, we successfully treated rhinophyma
with good cosmesis and no complications in an outpatient
setting. For patients with moderate rhinophyma
presenting with painful papulopustules and
nodularities of the nose, which are refractory to oral
UNCORRECTED PROOF
Figure 3. Six months after three Smoothbeam laser treatments.
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101

MJDT_A_486395.3d Wednesday, 9th June 2010 09:55:26
Letter 3
102 and topical medications, the Smoothbeam laser is a
103 safe, easy-to-handle, and effective treatment option.
104 Acknowledgement
105 The authors report no funding sources and no
106 conflicts of interest.
107 References
108 1. Roberts JO, Ward CM. Rhinophyma. J R Soc Med. 1985;78:
109 678–681.
110 2. Aloi F, Tomasini C, Soro E, Pippione M. The clinicopathologic
111 spectrumofrhinophyma.JAmAcadDermatol.2000;42:468–472.
112 3. No D, McClaren M, Chotzen V, Kilmer SL. Sebaceous hyper-
113 plasia treated with a 1450-nm diode laser. Dermatol Surg.
114 2004;30:382–384.
4. Noborio R, Nishida E, Morita A. Clinical effect of low-energy
double-pass 1450 nm laser treatment for acne in Asians. Photodermatol
Photoimmunol Photomed. 2009;25:3–7.
5. Tanzi EL, Williams CM, Alster TS. Treatment of facial rhytides
with a nonablative 1,450 nm diode laser: A controlled
clinical and histologic study. Dermatol Surg. 2003;29:
124–128.
6. Gupta AK, Chaudhry MM. Rosacea and its management:
An overview. J Eur Acad Dermatol Venereol. 2005;19:
273–285.
7. Sadick H, Goepel B, Bersch C, Goessler U, Hoermann K,
Riedel F. Rhinophyma: Diagnosis and treatment options for
a disfiguring tumor of the nose. Ann Plast Surg. 2008;61:
114–120.
8. Madan V, Ferguson JE, August PJ. Carbon dioxide laser
treatment of rhinophyma: A review of 124 patients. Br J
Dermatol. 2009;161:814–818.
9. Paithankar DY, Ross EV, Saleh BA, Blair MA,
Graham BS. Acne treatment with a 1,450 nm wavelength laser
and cryogen spray cooling. Lasers Surg Med. 2002;31:
106–114.
UNCORRECTED PROOF
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135