BackgroundWhereas early rhinophyma is histopathologically thought to resemble fully developed rosacea, a fibromatous variant has previously been described for severe rhinophyma. In terms of clinical characteristics, recently a new Rhinophyma Severity Index (RHISI) was introduced.MethodsWe studied 24 patients who had been treated with wide shave excisions for rhinophyma. Specimens were stained with hematoxylin‐eosin, periodic acid‐Schiff reaction and a panel of immunohistochemical stains and observed for any correlation between clinical severity and histopathologic features as well as for predictive markers of clinical recurrence.ResultsThere were no significant histopathologic differences between the groups reflecting the different clinical expressions. From a histopathologic perspective, clinically severe forms did not show with exclusive fibrotic changes. Further, there was no histopathologic marker predicting the clinical course or possible recurrence of the disease after surgical treatment. Only the clinical pre‐operative RHISI score correlated with the postoperative outcome, with a high pre‐operative RHISI being a risk factor for recurrence.ConclusionHistopathologic features do not correlate with the clinical expression of rhinophyma. An exclusively ‘fibrotic’ rhinophyma form does not appear to exist and could possibly be the result of sampling error based on small biopsies studied.