Journal : Photographic review of medicine & surgery ; vol. 2., no. 4.
Philadelphia : J. B. Lippincott & Co., 1870-71.
Description : pp. 32-34,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Skin — Acne rosacea.
THE accompanying photograph represents a man who came under my notice about a year and a half ago, and from whom I obtained the following facts relative to his trouble. His age is seventy-five, and for the last fifty years he has been a traveling merchant, leading an active life in the open air. He has always been in good general health, remarkably temperate in his habits, and rarely indulging in alcoholic drink of any kind. The nose first began to increase in bulk about fifteen years ago. before which time it was of normal size, not being considered even a prominent nose. At this period " small lumps" appeared upon the sides of his nose, which from time to time would become red and swollen, giving out sebum upon pressure. A large lump now came upon the right ala, which did not pass away, but continued increasing steadily in size for nine years, the rest of the nose remaining in a normal condition. This enlargement did not extend beyond the median line of the organ. Six years ago the left side first began to show signs of growth, increasing rapidly and extending upward to join the tumor from the other side.
At present the whole nose is enlarged in a most marked degree, and studded with round, pediculated tumors, varying in size from a pea to a cherry. These are eight in number and press one against the other so closely as to abrade the skin upon their surfaces, allowing the sebum to collect and form smegma. The whole protuberance is highly vascular, slightly red or violaceous in color, with a temperature higher than normal. When squeezed, the sebaceous glands give forth large plugs of sebum, and the great vascularity of the growth is more apparent. There is no special pain on pressure, and the sensibility of the part remains unimpaired. The body of the nose, at its greatest circumference, measures six and a half inches. When he shakes his head the whole nose moves as a pendulous tumor, and he complains of its weight ; beyond this but little inconvenience from its presence is experienced. The growth is not connected with the inside of the nose, the nostrils being open and free. Nothing of the tumor can be felt from inside the nostrils.
The case before us is interesting, both on account of the unusual development of the affection, and also the absence of any of the causes to which the growth might be attributed. It is well known that excess in the use of alcohol may bring about changes in the tissues of the nose similar to those which we see in the present instance ; but all cases of this disease are by no means to be attributed to the use of this stimulant. Other causes, some of which arise within the body, others from without, as external irritants, are known at times to be productive of such conditions ; while, on the other hand, many cases of this trouble are traceable to no apparent cause. In the case under consideration there appears to be no assignable cause whatever for the growth, the patient having always led a most regular life and enjoyed the best of health. Tumors of this character occasionally grow with great irregularity, so as ultimately to assume most grotesque formations. A very curiously developed growth of this nature appears figured in Hebra's Atlas of Skin Diseases, where the whole nose has become distorted and enormously enlarged, resembling in form a large, irregularly developed and fissured white potato, placed transversely across the face, extending from cheek to cheek. Noses of this kind are known in Germany by the expressive name of "Pound Noses."
Rosacea, or acne rosacea, when once developed, may be considered as a new growth, consisting in the formation of increased connective tissue and new blood-vessels, attended, as a rule, with hypertrophy of the sebaceous glands. The disease usually begins with simple dilatation of the blood-vessels, and may terminate in this first stage, giving rise to but little deformity, or, as in the case before us, the process may run on to form a vascular tumor. The several stages of this affection, from the first manifest symptoms to the well-developed growth, present such different appearances that a division into grades or degrees may be adopted with propriety. Our patient represents the late stage, showing rather the results of this process than the disease in its active course.
At the same time the case well illustrates to what extent this trouble, beginning as a simple rosacea, may develop. Ordinary acne may or may not be associated with rosacea, for, according to present views, acne vulgaris and acne rosacea are distinct diseases. Acne vulgaris is not infrequently, however, present with rosacea, and it was probably this occurrence which led in times gone by to the name of acne rosacea. But a careful distinction should always be drawn between these two diseases, for our prognosis must be very materially affected by the presence of one or the other. As a rule, the prognosis of rosacea must be unfavorable, while, on the other hand, acne vulgaris always permits of a favorable termination.
In cases like the present, operative interference is the only treatment which can result in benefit. Considering, however, the age and condition of our patient, it was not deemed expedient to resort to any operation, he himself also preferring to keep the nose as it was the few years he might have to live.