Nasal Furuncle (Boil Inside the Nose)

What is a nasal furuncle?

A furuncle forms when bacteria get into a hair follicle and cause a deep infection with a pocket of pus. In the nose, it usually develops in the nasal vestibule, the skin-lined entrance to the nostril where coarse nose hairs grow. It can also form on the tip or outer side of the nose.

It is related to two other conditions:

Symptoms

• A red, hot, swollen, very painful lump inside the nostril or on the nose
• Pain that throbs and gets worse when you touch, wrinkle or blow your nose
• A white or yellow center (head) after a few days
• Swelling and redness of the nose tip
• Sometimes a low fever and tender lymph nodes under the jaw
• The boil may burst and drain pus, after which pain usually eases

Causes and risk factors

Staphylococcus aureus lives harmlessly inside the nostrils of about 1 in 3 people. It causes a boil when it enters damaged skin. Triggers include:

• Picking the nose or scratching inside the nostril
• Plucking or trimming nose hairs too close
• Frequent nose blowing during colds or allergies
• Nose piercings
• Dry, cracked skin inside the nose
• Diabetes, a weakened immune system or close contact with someone who has MRSA

Why you should not squeeze a nose boil: the danger triangle

The area from the corners of the mouth to the bridge of the nose is called the danger triangle of the face. Veins here connect with the cavernous sinus, a large vein channel at the base of the brain, and have no valves to stop backward flow. Squeezing a boil can push bacteria into these veins.

Complications are rare but serious:

• Cellulitis of the nose and cheek
• Orbital cellulitis, infection around the eye
• Cavernous sinus thrombosis, an infected blood clot that causes headache, high fever, eye swelling, bulging and loss of eye movement. It is an emergency.

Diagnosis

A doctor usually diagnoses a nasal furuncle by looking inside the nostril with a light. A swab of pus may be sent to check for MRSA, especially for repeated or severe infections. Blood tests and a CT or MRI scan are only needed if complications are suspected.

Treatment

Home care

• Warm compresses: hold a clean warm, damp cloth against the nose for 10 to 15 minutes, 3 to 4 times a day. Warmth improves blood flow and helps the boil drain on its own.
• Do not squeeze, pick or pop it, and do not pluck nearby hairs.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Hygiene: wash your hands before and after touching the area and use separate towels.

Medical treatment

• Antibiotic ointment such as mupirocin applied inside the nostril.
• Oral antibiotics active against staph are commonly prescribed for nasal furuncles because of the location, even when small. The choice depends on local MRSA rates.
• Incision and drainage: a doctor may drain a large, fluctuant boil with a small cut under local anesthetic. This should not be attempted at home.
• Hospital treatment with intravenous antibiotics is needed for spreading infection or eye or brain complications.

Most boils improve within 2 to 3 days of treatment and heal in 1 to 2 weeks.

Preventing nose boils

• Avoid picking your nose and plucking nose hairs. Use rounded scissors or a trimmer instead.
• Keep the inside of the nose moist with saline spray or a small amount of petroleum jelly in dry weather.
• For repeated boils, your doctor may recommend decolonization: mupirocin ointment in the nostrils twice a day for 5 days, plus antiseptic body washes, to clear staph carriage. Household members may also need treatment.
• Control blood sugar if you have diabetes.

Frequently asked questions

What causes a boil in the nose?

Most nose boils are caused by Staphylococcus aureus bacteria entering a hair follicle in the nostril. Common triggers are picking the nose, plucking nose hairs, frequent nose blowing during a cold, and piercings. People who carry staph in their nose, or who have diabetes, get them more often.

How long does a nose boil last?

With warm compresses and antibiotics if needed, most nose boils start improving within 2 to 3 days and heal in 1 to 2 weeks. A boil that is still growing after a few days, or that comes with fever or spreading redness, needs to be seen by a doctor.

Is a boil in the nose dangerous?

Usually not, but it needs more care than a pimple elsewhere. The nose sits in the danger triangle of the face, where veins drain toward the brain. Infection can rarely spread to the eye socket or cause a clot in the cavernous sinus. Warning signs are eye swelling, severe headache and high fever.

Should I pop a boil inside my nose?

No. Squeezing or popping a nose boil can push bacteria deeper and into veins that connect with the brain. Use warm compresses to help it drain naturally, and see a doctor if it is large, very painful or not improving. A doctor can drain it safely if needed.

Is a pimple inside the nose the same as a boil?

Not always. A small pimple is a blocked pore or mild follicle infection near the surface. A boil is deeper, more swollen and more painful, often with a pus-filled head after a few days. Both deserve gentle care, but a large or very painful bump is more likely a furuncle and may need antibiotics.