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Otophyma: A Case Report and Review of the Literature of Lymphedema (Elephantiasis) of the Ear

Carlson, J Andrew MD, FRCPC*; Mazza, Jill MD*; Kircher, Kenneth DO; Tran, Tien Anh MD

The American Journal of Dermatopathology: February 2008 - Volume 30 - Issue 1 - p 67-72
doi: 10.1097/DAD.0b013e31815cd937
Extraordinary Case Report

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.

From the *Divisions of Dermatology and Dermatopathology, Albany Medical College, Albany, NY; †Advanced Dermatology, Lake Katrine, NY; and ‡Department of Pathology, Florida Orlando Hospital, Orlando, FL.

Reprints: J. Andrew Carlson, MD, FRCPC, Divisions of Dermatology and Dermatopathology, Albany Medical College MC-81, 47 New Scotland Ave., Albany, NY 12208 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.