The Medical Consumer's Advocate

Sores in the nose

 

Q: I have sores inside my nose. They seem to be worse in the fall and winter. Could you please help me with this problem? I have been told that it is caused by a lack of something in my system.

A: A lack of something in your system? If I was stumped and felt compelled to lie, I would at least come up with something a bit more creative than "a lack of something in your system."

Unfortunately, you have not given me enough details to make a diagnosis... and if I cannot even guess your diagnosis, I certainly cannot suggest a treatment.

Ah, hell, let’s do both. When someone tells me they have sores in their nose, they are often describing a scaly/crusty lesion that occurs high within the nostril. Point your fingertip at the part of your nostril which is closest to the tip of your nose. Now, imagine putting your fingertip into your nostril in this same area. Not that you would ever do this of course.

Is this the area where the sores are forming? Do the sores form yellow crusts? When the crusts come off, is the tissue underneath "weepy" (moist)? If the answers to these questions are "yes," then you have nasal impetigo. Impetigo is an infection with Staphylococcus (a bacterial infection.) The fingertips harbor Staphylococcus, so an important part of treatment is the strict maintenance of physical distance between the fingertips and the nasal cavity. These infections do not respond to most topical antibiotic ointments, and are even very resistant to most anti-Staphylococcal oral antibiotics. I have had good results using a prescription antibiotic ointment, mupirocin (trade name, Bactroban.) Of course, you will need to discuss this with your doctor (bring a copy of this letter with you), so that he/she can confirm the diagnosis and write the prescription.

What else could it be? Some people develop recurrent infections of the nasal hair follicles. This is known as folliculitis. This, too, is often caused by Staphylococcus, but unlike nasal impetigo, folliculitis will often respond to anti-Staphylococcal oral antibiotics. Folliculitis can, of course, occur anywhere in the nose where you have hair follicles.

Much less common than impetigo or folliculitis would be cold sores (herpes simplex), which are far more common in and around the oral cavity. Prescription anti-viral creams that are used to treat oral herpes simplex should also work for nasal herpes simplex. Cold sores have a characteristic appearance: soon after they "break out," one can see several small, red bumps that are clustered together.

Do you use any nasal sprays (prescription or over-the-counter)? Do you put anything into your nose that does not belong there? Are you inhaling noxious fumes (are you a painter, for instance)? If the answer to any one of these questions is "yes," then the sores may reflect hypersensitivity (allergy) to a particular substance. Avoidance of the substance in question should enable you to avoid the sores.

My recommendation: see an ear, nose and throat specialist; if possible, see the ENT when you have the sores in your nose. ENTs are very familiar with this problem and know a number of ways to successfully treat it.

 

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