Rhinophyma is a condition causing development of a large, bulbous nose associated with granulomatous infiltration, commonly due to untreated rosacea. The condition is most common in older white males.Colloquial terms for the rhinophyma include "whiskey nose", "gin blossom", "toros nose", and "potato nose". Signs and symptoms
Rhinophyma is characterised by prominent pores and a fibrous thickening of the nose, sometimes with papules. It is associated with the common skin condition rosacea and it can be classified clinically into 5 grades of increasing severity. Complications
Tissue thickening may come to cause airway obstruction and impede breathing.Rhynophyma cause psychological distress due to its effect on ones personal appearance and social perceptions of a link with alcoholism. Causes
Rhinophyma develops in certain individuals with an unknown predisposition from long-standing rosacea which has progressed to a severe form.Although rhinophyma has been commonly presumed to be linked to alcoholism, a direct causal relationship between the condition and excessive alcohol consumption has not been substantiated. Alcohol may cause increased flushing in those affected. Pathophysiology
Rhinophyma develops in some individuals after long-standing rosacea that has progressed to acne rosacea.Rosacea usually commences in people between the age of 20-30 years. Rosacea begins with facial flushing (pre-rosacea). The nasal skin then thickens and hypervascularises, leading to persistent erythema (vascular rosacea). Papules and pustules then develop, marking the beginning of acne (inflammatory) rosacea. A subset of those affected by acne rosacea go on to develop rhinophyma.
Adverse reactions for at least 5% of people taking it were hypoglycemia, nausea, nasopharyngitis, diarrhea, upper respiratory tract infections, and headache. In Study A (N=469), symptoms of hypoglycemia were recorded in 25.6% of people with zero cases of severe symptomatic hypoglycemia. Study B (N=365) had a 40% incidence of hypoglycemic events with 1.1% incidence of severe hypoglycemia requiring assistance. Interactions
Lixisenatide and other GLP-1 receptor agonist slow emptying of stomach contents, which may affect the absorption of orally administered medications. For effective use, oral contraceptives should be taken 1 hour before or 11 hours after taking lixisenatide-containing products. Acetaminophen and antibiotics are among other drugs that are affected by this action of lixisenatide. History
Lixisenatide is a GLP-1 receptor agonist that was created by Zealand Pharma A/S of Denmark; in 2003 Zealand licensed it to Sanofi which developed the drug. Lixisenatide was approved by the European Commission on February 1, 2013. Sanofi submitted an NDA in the US, which was accepted for review by the US FDA in February 2013 but after discussions with the FDA about the cardiovascular safety data included in the package (starting in 2008, the FDA had required stronger CV safety data for new anti-diabetes drugs, following the controversy around the risks of Avandia) Sanofi decided to withdraw the NDA and wait for the results of a Phase III study that was scheduled to be completed in 2015.