Rhinophyma or bulbous nose

Domenico Ghirlandaio
1449, Florence – Jan. 11, 1494, Florence, Italy

♦ Old Man with a Child (Count Francesco Sassetti with his Grandson) 1490 ♦

Francesco Sassetti was a 15th-century banker and an influential patron of the arts. His portrait reflects the grace, dignity, inner calm, and robust bearing of old age. The portrait is regarded as Ghirlandaio’s masterful depiction of the intense bond between the old man and the child.

♦ Diagnosis
Main symptoms: Hypotrophic thickening and nodular formation of the skin on the nose; naevus mollis in the temporal region.
Secondary symptoms: Old man with a red face.
Clinical diagnosis: Rhinophyma

♦ Definition: rhinophyma
Rhinophyma is a form of acne rosacea affecting the nose, characterized by excessive growth of blood vessels, sebaceous glands, and connective tissue, resulting in a bumpy appearance of the tip of the nose. It is sometimes referred to as a “drinker's nose” or “gin nose” due to the possible role of alcohol abuse in its development.

♦ Discussion
Domenico Ghirlandaio was a Florentine painter. His style was solid, prosaic, and a touch old-fashioned, especially when compared to the greats of his time, such as Botticelli. He was, however, an excellent craftsman and a shrewd businessman. He ran one of the most prosperous studios in Florence. He also painted portraits, of which *Old Man with Grandson* is one of the most refined. He depicted the grandfather’s symptoms of illness with merciless realism, yet managed to imbue the man with a remarkable kindness and gentleness.
This painting is strongly influenced by the art of the Low Countries. Here, Ghirlandaio imitated a portrait style that was in vogue in the Netherlands. He strove—in details such as hair, fur, or foliage—to emulate the effects of artists like Memling..

Rhinophyma is one of the most commonly identified clinical diagnoses in works of art. A bulbous nose is considered unusual and unattractive and disfigures the face. Because such paintings were difficult to sell, the artist often did not hesitate to simply paint over the nose. There are other clinical syndromes that can result in such a bumpy, irregular, and non-ulcerated nose, as Ghirlandaio has depicted here.

We can immediately rule out certain fungal diseases, such as blastomycosis, coccidioidomycosis, and histoplasmosis, due to their typical geographic distribution.
Mycobacterium tuberculosis can affect the face, but the lesions usually ulcerate. Lepromatous leprosy is also a likely possibility, were it not for the fact that the bridge of the nose is well-preserved here, as are the eyebrows. Sharma believes that Francesco Sassetti may have suffered from sarcoidosis. The associated nasal condition is of the lupus pernio type.
Most dermatologists, however, consider it a typical case of rhinophyma.

Source: Jan Dequeker

♦ Rhinophyma or bulbous nose
Strawberry nose is a specific form of rosacea. In this condition, the nose is red, bumpy, and covered with telangiectasia. This form is particularly common in men. Such a nose in no way indicates excessive alcohol consumption, as patients are often accused of.

The treatment of rhinophyma, or a bulbous nose, is entirely different from other types of rhinoplasty. It involves a skin condition affecting the skin over a normal underlying structure of the nasal skeleton, cartilage, and subcutaneous tissue. Due to the continuous enlargement of sebaceous glands, the nose takes on a bulbous shape with an irregular surface. The fine blood vessels just beneath the skin’s surface dilate abnormally, giving the nose a vascular appearance. Rhinophyma is a facial skin condition. Treatment therefore begins with a consultation with a dermatologist (skin specialist). Once the skin growth on the nose has progressed too far to respond to medication, surgical correction may be indicated. Under local or general anesthesia, the skin of the nose is shaved off. A drying dressing gradually comes off after healing (two to three weeks).

Jan Dequeker
The artist and the doctor are looking at paintings

Photo
wikimedia.org