1. Antibiotics guide
2. Contraception series
3. Heart failure
4. Urinary tract infections (UTI) – an overview of lower UTI management in adults
5. Hypertension in adults: the silent killer
6. Melatonin: is it worthwhile for sleep?
7. Prescribing statins to reduce cardiovascular risk
8. Scabies: diagnosis and management
9. H. pylori: who to test and how to treat
10. Vitamin D supplementation: an update

We all suffer from a red nose every now and then. Often it is triggered by something specific, such as a cold, allergies, sun/windburn, strong emotions (e.g. crying, embarrassment, anger) or spicy food. The terms “whiskey nose” or “rum blossom” have been used in the past to describe a crimson hue of the nose that arises from one too many alcoholic beverages. For most people, a red nose is not a cause for concern, as the redness is temporary and resolves once the trigger has been eliminated. But for some, a red nose becomes chronic and can thicken and become bulbous – and no, we are not still talking about Rudolph!

Rhinophyma (derived from the Greek words rhis/rhino meaning “nose” and phyma meaning “growth” or “skin tumour”) is a skin condition that can occur in severe rosacea when sebaceous glands enlarge and the underlying connective tissue of the nose proliferates.^{1, 2} The nose often appears red with prominent blood vessels, and the skin may be bulbous, pitted and scarred.^{1, 2} It more often affects males and increases in prevalence with age.^{3, 4} It can also occur in people without rosacea (less common).⁴ A direct cause has not been established but vasodilation and vascular instability are thought to be involved which may predispose to skin thickening, and fluid leakage into the skin which can trigger inflammation and fibrosis.² Discussion with, or referral to, a dermatologist for treatment (e.g. topical azelaic acid, isotretinoin, laser) is important, as not only does rhinophyma psychologically affect a person, it can also cause obstructive respiratory issues and can mask other skin conditions such as basal cell carcinoma.^{1, 3}

What about noses as we age; do they keep growing?

You may have heard that your nose (and ears) never stop growing, but contrary to popular belief, this is not exactly true. While the ageing process does impact the appearance of these facial structures over time, they are not constantly growing.

As we age, the effects of gravity start to take hold and the skin undergoes changes such as a loss of elasticity, pliability and hydration.^{5, 6} There is also a weakening of cartilage and the skin’s connective tissues, which results in skin laxity (saggy appearance).^{5, 6} Lax skin covering a weaker cartilage structure can make the nose (and ears) appear longer.⁵ Other changes to the face that occur with ageing, e.g. soft tissue atrophy causing thinner cheeks, can also make the nose appear larger.⁵ Noses might also change in structure over time (e.g. nasal tip ptosis, development of a dorsal/pseudo hump) due to the age-related skin and cartilage changes, e.g. through decreased pliability of the skin and weaking of the nasal cartilage tip support.⁶

And Rudolph’s red nose? It turns out that reindeer residing in the arctic region really do have a distinct colouration at the tip of their nose. A study published by the BMJ found that reindeer have higher vascular density in their nose and therefore more capillaries, resulting in a characteristic red appearance. Increased vasculature helps to protect the nose from freezing during the cold conditions in the North Pole and when flying high up in the sky, and it can also help to regulate brain temperature in these conditions making these alert animals ideal companions for Santa on his travels.

• This small Danish randomised controlled trial was carried out in 2024 and involved 31 friends and family (of the researchers) who were aged 18 years and over and had previously received at least one Christmas gift per year
  • The median self-reported Christmas joy score was eight (interquartile range [IQR]= 6 – 9) on the Christmas-adapted Wong-Baker faces scale
  • Participants who reported an allergy to gift wrapping materials, had a Christmas joy score of zero (Bah humbug) or cognitive/sensory impairments that could affect their ability to evaluate the gifts were excluded
• The outcomes of the study were to identify the optimal Christmas gift wrapping and to compare the effect of a good gift versus placebo
• Participants were randomly presented with a total of 27 individual gifts including an unwrapped control gift and initial reference gift wrapped in red. Subsequent gifts varied in wrapping paper colour or pattern, size and weight, softness, sound that the contents made when shook and decorations, e.g. bow, rosette, manila tag, generic two-line card or a longer personalised 14-line card.
  • Two gifts wrapped identically to the reference gift (and weight adjusted) were included to answer whether a good gift was associated with more joy compared to a placebo gift
  • All gifts were wrapped by the same person for consistency
• Participants had the opportunity to examine the gift, i.e. hold, look at and shake, before rating on a scale of zero to ten based on how happy they would be to receive it
• Gold or Christmas-themed wrapping paper improved the score by 1.48 points (95% confidence interval [CI] = 0.6 – 2.4), compared to the reference red wrapping paper. Unsurprisingly, the gift with no wrapping paper performed poorly.
• Gifts that were bigger, heavier or softer than the reference gift were also associated with high scores; a large gift increased the Christmas joy score by 3.6 points (95% CI = 2.6 – 4.5), a heavier gift increased the score by 3.5 points (95% CI = 2.6 – 4.4) and knitted socks were associated with a 1.9 point increase (95% CI = 1.0 – 2.8) compared to the reference gift
• The largest increase in Christmas joy score was associated with a long personalised card (5.42 points [95% CI = 4.4 – 6.3]). Other decorative elements that increased scores compared to the reference gift included a bow, manila tag and a standard two-line Christmas card.
• Higher scores were also observed for gifts with sound effects, e.g. rattling LEGO bricks or broken porcelain, or those with longer written cards explaining that the gift was expensive or difficult to procure
• In terms of Christmas joy score per unit of wrapping time, a small gift box was considered more efficient than large bows or personalised long cards
• Interestingly, no increase in joy was observed between receiving a good gift (a gift card for 500 Danish krone) compared to an identical-looking placebo gift (a 10 mL syringe). Suggested reasons for this include the participants guessing the gift contents (presumably reducing the excitement of receiving the gift card) or inadequate blinding or study power by the researchers.
• The researchers do point out that participants did not unwrap any of the gifts they evaluated, and therefore the study should be interpreted with caution. It is possible that the participants’ emotional response was muted due to not seeing what the gifts actually were (other than the placebo/gift card), and the discrepancy between expectation and reality may come into play.