Excessive sweating may precede other changes by several years. With persistent hyperhidrosis, diffuse erythema develops on the tip of the nose. Erythema gradually extends and may involve cheeks, upper lip, and chin. Erythema is covered by small beads of sweat that also may be evident over a wider area. Small erythematous macules, erythematous papules, and vesicles or pustules may form at the sweat duct orifices.
Many affected patients have poor peripheral circulation and hyperhidrosis of palms and soles.
Pathogenesis is unknown. Granulosis rubra nasi is a nonneoplastic disorder of the eccrine glands, possibly representing a unique form of sweat retention. Eccrine glands produce sweat, and an alteration in the rate of sweat secretion manifests as hypohidrosis or hyperhidrosis. A marked increase in sweat production on the nose occurs in granulosis rubra nasi. Hyperhidrosis also is present on the central face, palms, and soles.