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E-IJD RESIDENTS' PAGE |
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| Year : 2016 | Volume
: 61
| Issue : 2 | Page : 234 |
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| Nose: Applied aspects in dermatology |
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Dammaningala Venkataramaiah Lakshmi, Kanathur Shilpa, Holavanahally Veerabhadrappa Nataraja, Kallapa Gorur Divya
Department of Dermatology, Venereology and Leprology, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| Date of Web Publication | 1-Mar-2016 |
Correspondence Address:
Dammaningala Venkataramaiah Lakshmi
Department of Dermatology, Venereology and Leprology, No. 52/53, OPD “B” Block, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru - 560 002, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.177782
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 Abstract | | |
Nose is the most prominent part of the mid-face and has important physiological, aesthetic and psychological functions. Skin diseases on the nose are commonly seen by dermatologists, otorhinolaryngologists, and plastic surgeons. Because of its exposed, highly visible localization, lesions on the skin of the nose are often noticed by patients themselves, typically very early in the course of the disease. Similarly, the dermatological lexicon is well known with descriptive terminologies, synonyms, acronyms, eponyms, toponyms, misnomers. We have tried to compile the anatomical applications of nose in cosmetology and dermatosurgery subspecialities with nasal eponyms and signs encountered in clinical dermatology that would be helpful for residents.
Keywords: Eponyms, mutilating rhinopathies, nose, signs
How to cite this article:
Lakshmi DV, Shilpa K, Nataraja HV, Divya KG. Nose: Applied aspects in dermatology. Indian J Dermatol 2016;61:234 |
What was known?
Facial dermatoses are a common dermatological complaint with several conditions under its umbrella. The clinical characteristics guide in their evaluation and diagnostic judgment. Nose forms an integral anatomical structure that helps to distinguish these conditions in many scenarios.
| Introduction | |  |
Nasal topography and its external subunits have a unique significance in understanding the dermatoses involving the face and also are of utmost importance in cosmetic/dermatosurgical procedures for planning reconstruction surgeries. This article comprises anatomical applications of nose, nasal eponyms, and signs encountered in dermatology that are important in the daily practice of a dermatologist.
Nose has the most subdivisions on the face, the horizontal root, which borders the glabella on the forehead, is positioned superiorly. The midnose contains the dorsum medially flanked by the two lateral sidewalls. The dorsum is inferiorly bordered by the tip, which ends in the columella that separates the nostrils on the underside of the nose. The tip is bordered by the ala nasi, or alae, on both sides, and the columella is flanked by the soft triangles, which also border the tip and the alae.
| Clinical Applications of Nasal Anatomy | | |
The skin in the areas of the dorsum, columella, and sidewalls is thin, loose, compliant, and relatively less sebaceous, while the skin in the areas of the nasal tip and alae is thicker, more sebaceous, more adherent, and less flexible. The nose with its rich pilosebaceous skin at the nasal tip and alae can frequently exhibit comedones, sebaceous hyperplasia, rosacea, trichoepithelioma, trichostasis spinulosa, and trichofolliculoma [Figure 1].
The anatomical characteristics and clinical significance are shown in [Table 1]. | Table 1: The anatomical characteristics of nose and their clinical significance
Click here to view |
| Nose Eponyms | | |
[Table 2] shows the nasal eponyms.
| Nose Signs | | |
The nose related signs are tabulated in [Table 3].
| Mutilating Rhinopathies | | |
The common dermatological causes of mutilating rhinopathies include Lepromatous leprosy, Leishmaniasis, Lupus vulgaris, Lues maligna (syphilis), Lupus pernio, and Lethal midline granuloma (6 Ls) [Figure 4].
The nasal bone destruction and saddle nose deformity in the late stages of yaws constitutes gangosa, while goundou refers to hyper osteitis of the nasal process of the maxillae which gives rise to swellings on both sides of the bridge of the nose.
Acute rhino-orbital-cerebral zygomycosis caused by Mucor, Rhizopus, Rhizomucor, and Absidia
is characterized by the progressive infection of upper turbinates or paranasal sinuses that leads to necrosis, mutilation of nose, ophthalmoplegia, and orbital cellulitis[Figure 2]. | Figure 2: (a) Nasolabial sparing in systemic lupus erythematosus (b) pinched nose in systemic sclerosis
Click here to view |
Rhinoentomophthoromycosis (subcutaneous zygomycosis) caused by conidiobolus and basidiobolus of class zygomycetes is characterized by painless, nonulcerating nasal swellings in inferior turbinates that extends to subcutis causing woody induration, obliteration of nasal cavity, mucosal thickening, and is disfiguring.
In congenital erythropoietic porphyria, scarring when deep may involve cartilage, ligaments, and bone with severe mutilation of fingertips, ears, and nose with hypertrichosis of face termed as wolf appearance.[34]
Cutaneous carcinomas such as basal cell carcinomas and squamous cell carcinomas can also cause disfigurement of nose.
| Miscellaneous | | |
Developmental midline anomalies of nose
Congenital nasal masses include dermoid cyst, dermal sinuses, cephaloceles, and heterotopic brain tissue (nasal gliomas) resulting from the faulty embryologic development of the frontobasal skull and/or adjacent ectodermal/neuroectodermal tissues.[35] It is important to recognize these as they can have intracranial communication.
Benign neoplasms in infancy that occur on the nose are infantile hemangioma [Figure 3], hemangiopericytoma, neurofibroma, melanotic neuroectodermal tumor of infancy, hamartomas (chondromesenchymal, chondroid, lipomatous, and angiomatous). Malignant neoplasms include rhabdomyosarcoma, fibrosarcoma, osteosarcoma, and neuroblastoma.[35] | Figure 4: (a) Mutilating rhinopathy due to discoid lupus erythematosus (b) saddle nose deformity
Click here to view |
Congenital absence and duplication anomalies of nose
Arrhinia
Congenital absence of nose, nasal bones, cribriform plate, nasal septum, paranasal sinuses, and olfactory bulbs are associated with hypertelorism and high arched palate.
Polyrhinia
Existence of two external noses due to the development of two nasal placodes, which then undergo normal development and is associated with choanal atresia.
| Supernumerary Nostrils | | |
It is an extra opening, lateral, medial, or superior to the normal nostril, which may or may not communicate with nasal cavity. It may be unilateral or bilateral resulting from the localized abnormality of the lateral nasal process in which a fissure appears accidentally during mesenchymal proliferation.
Bifid nose
It is a rare congenital deformity due to failure of the paired nasal processes to fuse to a single midline organ during early gestation.
Midface hypoplasia
It is seen in craniofacial syndromes such as Aperts syndrome, Achondroplasia, Crouzon syndrome, Carpenters syndrome, Saethre-Chotzen syndrome, Marshall Stickler syndrome, Pfeiffer syndrome, Zellweger syndrome, Mucopolysaccharidosis [5] (coarse facies with midfacial hypoplasia).
Prenatal exposure to drugs such as phenytoin (short nose and anteverted nostrils), warfarin (nasal hypoplasia), isotretinoin, and alcohol also cause midfacial hypoplasia.[36],[37],[38],[39]
Centrofacial melanosis
Centrofacial melasma is the most common facial melanosis, this variant occurs in 63% of melasma patients compared to maxillary and mandibular types.[40][Figure 5], [Figure 6]b. Pigmentation involves cheeks, nose, forehead, and chin. Post chikungunya pigmentation (chik sign) and Type I and Type III nevus of OTA involve the nose. In Type IB, mild zygomatic type nevus involves infrapalpebral fold, nasolabial fold, and zygomatic region and in Type ID, only ala nasi is involved. In Type III severe form, nevus involves scalp, forehead, eyebrow, and nose[Figure 7].[40] | Figure 7: (a) Headlight sign in atopic dermatitis (b) Pavithran's nose sign on erythroderma
Click here to view |
| Conclusion | | |
Nose constitutes the central anatomical structure of face with esthetic importance and its impact on the individual psyche has enhanced the significance of nose. We must be familiar with the special morphology and characteristics of skin diseases of the nose that gives clinical clues in understanding and identifying the conditions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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What is new?
This article is a compendium of regional dermatosis of the nose that specially highlights eponyms and signs.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3] |
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