A 58-year-old Caucasian man presented to the dermatology clinic with a massive deformity of his nose. Gradual thickening of his nasal skin had been apparent over the past several decades, with rapid enlargement occurring over the past 2 years. It had begun to interfere with daily activities such as eating, drinking, and even breathing. He did not complain of rosacea-related concerns such as acneiform papules, telangiectasias, or ocular symptoms. Previous treatments with topical and oral antibiotics had been unsuccessful. Physical examination revealed a 4-cm overgrowth of his distal nose (Figure 1A, B), distorting his nasal cartilage and obstructing his mouth.
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