title: Otophyma: a case report and review of the literature of lymphedema (elephantiasis) of the ear.
abstract: Phymas (swellings, masses, or bulbs) are considered the end-stage of rosacea and mostly affect the nose (rhinophyma), and rarely involve the chin (gnatophyma), the cheek (metophyma), eyelids (blepharophyma), or ears (otophyma). Herein, we report the case of a 57-year-old man who developed unilateral enlargement of his left ear over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with Demodex infestation. Corticosteroid and minocycline therapies resulted in partial reduction of the ear enlargement. Literature review examining for cases of lymphedema (elephantiasis) of the ear revealed that chronic inflammatory disorders (rosacea (most frequent), psoriasis, eczema), bacterial cellulitis (erysipelas), pediculosis, trauma, and primary (congenital) lymphedema can all lead to localized, lymphedematous enlargement of the ear. Depending on the severity, medical treatment directed at the inflammatory condition for mild, diffuse enlargement to surgical debulking for extensive diffuse enlargement or tumor formation can improve the signs and symptoms of otophyma. Decreased immune surveillance secondary to rosaceous lymphedema may explain why Demodex infestation is common in rosacea and support the suspicion that phymatous skin is predisposed to skin cancer development.
authors.affiliation: Division of Dermatology, Albany Medical College, 47 New Scotland Ave., Albany, NY 12208, USA. carlsoa@mail.amc.edu
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Carlson
authors.forename: Jill
authors.initials: J
authors.lastname: Mazza
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kircher
authors.forename: Tien Anh
authors.initials: TA
authors.lastname: Tran
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000437:Alcoholism; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004426:Ear Deformities, Acquired / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D004604:Elephantiasis / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D011345:Fenofibrate / Q000627:therapeutic use; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007306:Insecticides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D008924:Mite Infestations / Q000473:pathology; D019964:Mood Disorders / Q000188:drug therapy; D026023:Permethrin / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012393:Rosacea / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D014221:Triamcinolone / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D018687:Antidepressive Agents, Second-Generation; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D007306:Insecticides; D005473:Fluoxetine; D006852:Hydrochlorothiazide; D014221:Triamcinolone; D026023:Permethrin; D003622:Dapsone; D008911:Minocycline; D004318:Doxycycline; D011345:Fenofibrate; D011241:Prednisone