Otophyma

Introduction:

Otophyma is the term used to describe sebaceous gland hypertrophy and hyperplasia of the pinna. It is usually considered to be the end stage of rosacea. This disorder is considered to be a chronic cutaneous disorder of unknown etiology.

Phyma is a greek word meaning “growth”. Usually it is caused by sebaceous gland hyperplasia and hypertrophy of the surrounding fibrous tissue. These Phymas are named according to the site of affliction.

Rhinophyma – when nose is affected.

Gnatophyma – When chin is affected

Metophyma – when forehead is involved

Otophyma – When pinna is involved

Blepharophyma – When eyelids are involved

Otophyma or rosaceous lymphoedema can either be unilateral / bilateral. Eventhough Rosacea is a common cutaneous disorder of unknown etiology affecting females otophyma is very rare.

Diagnosis:

The diagnosis of otophyma is made purely on clinical basis. Biopsy is necessary to differentiate this from similar looking diseases like lupus, carcinoma and angiosarcoma. Histopathology reveals hyperplasia and hypertrophy of sebaceous glands. The ducts of these glands appear dilated, convoluted and plugged. There is also associated proliferation of fibroblasts and presence of bacteria and inflammatory cells. Demodex folliculorum mite is commonly seen.

Management:

Early lesions which happen to be hyperemic respond to oral antibiotics like tetracycline and metronidazole. Late stages may require surgery.

Surgery:

Full thickness excision with split thickness graft

Full thickness excision with full thickness graft

Decortication – partial excision / shaving of the lesion. Cryo surgery has also been used in decortication procedures