Nasal Vestibulitis

What nasal vestibulitis is

The nasal vestibule is the first centimeter or so inside each nostril. Unlike the rest of the nasal passage, which is lined with moist mucous membrane, it is lined with skin that contains hair follicles, sweat glands and oil glands. This skin can become infected just like skin elsewhere.

Up to a third of people carry Staphylococcus aureus in the front of the nose without problems. When the skin is broken, the bacteria get in and infect the hair follicles (folliculitis) or the surrounding skin. If a deeper pocket of pus forms, it is called a nasal furuncle (boil).

Causes and risk factors

• Nose picking: the most common cause, especially in children
• Frequent nose blowing during colds or allergies, which irritates the skin
• Plucking or trimming nose hairs
• Nose piercings
• Dry indoor air causing cracks and crusts
• Nasal discharge constantly wetting the skin, as with rhinitis or a runny nose
• Nasal sprays and cannulas: nasal oxygen and CPAP masks can rub the skin
• Cancer treatment: some targeted therapies, such as EGFR inhibitors and certain chemotherapy drugs, often cause vestibulitis
• Diabetes and weakened immunity

Symptoms

• Redness and swelling just inside the nostril and at the nostril rim
• Tenderness, especially when touching or moving the nose
• Crusting and scabs that may bleed when removed
• Small red bumps or pimples around nose hairs
• A painful, firm boil that may come to a yellow head
• Mild nosebleeds from cracked, irritated skin
• With spread: redness and swelling of the nose tip and upper lip

Why nose infections need attention

The veins of the central face, including the nose and upper lip (sometimes called the "danger triangle"), drain toward the cavernous sinus, a large vein behind the eyes. Very rarely, infection spreads along these veins and causes cavernous sinus thrombosis, a life-threatening condition. This is why you should not squeeze boils or pimples in or around the nose, and why spreading redness or eye symptoms need urgent care.

How it is diagnosed

A doctor usually diagnoses nasal vestibulitis by looking inside the nostril with a light. A swab may be taken if:

• the infection is severe, recurrent or not responding to treatment
• MRSA is suspected (MRSA is a strain resistant to common antibiotics)

Other conditions that can look similar include impetigo (honey-colored crusts that spread), cold sores (painful clustered blisters), allergic or irritant dermatitis, and, in a sore that does not heal, skin cancer.

Treatment

Mild vestibulitis

• Topical antibiotic ointment such as mupirocin (prescription) or bacitracin, applied inside the nostril with a clean cotton swab 2 to 3 times a day for 5 to 10 days.
• Warm compresses on the outside of the nose for 10 to 15 minutes, several times a day, to ease pain and help any small boil drain.
• Stop picking and plucking. Keep fingernails short.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.

More severe infection

• Oral antibiotics effective against staph, chosen based on local MRSA rates, for a boil, spreading redness or fever.
• Drainage of a large furuncle by a doctor if it does not settle. Do not squeeze it yourself.
• IV antibiotics in hospital if infection spreads to the face or eye area.

Recurrent vestibulitis

• A swab to check for MRSA and identify the bacteria.
• Decolonization: mupirocin ointment inside both nostrils twice daily for about 5 days, sometimes with antiseptic body washes, to reduce staph carriage.
• Treat underlying causes such as allergies, dry air or constant nose blowing.

Prevention

• Avoid picking your nose or plucking nose hairs. Use rounded trimming scissors or a trimmer instead, and only for hairs that protrude.
• Moisturize the inside of the nostrils with a thin layer of petroleum jelly or saline gel in dry weather. Do not use petroleum jelly while using oxygen.
• Use a humidifier in dry indoor environments.
• Blow your nose gently, one side at a time, using soft tissues.
• Wash your hands regularly, especially during colds.

Frequently asked questions

What causes a sore inside the nose?

The most common cause is nasal vestibulitis, a staph infection of the skin just inside the nostril, often triggered by nose picking, blowing or plucking hairs. Other causes include dry air, cold sores, allergies and, rarely, skin cancer. A sore that lasts more than 2 weeks should be checked.

How do you treat nasal vestibulitis at home?

Apply warm compresses several times a day, stop picking or plucking, keep the area moist with a thin layer of petroleum jelly, and use an over-the-counter antibiotic ointment such as bacitracin. If it does not improve in a few days or spreads, see a doctor for mupirocin or oral antibiotics.

How long does nasal vestibulitis last?

Mild cases usually improve within a few days of treatment and clear within 1 to 2 weeks. A boil may take longer. Recurring infections can happen if staph bacteria remain in the nose or the trigger, such as nose picking, continues.

Is nasal vestibulitis contagious?

The staph bacteria that cause it can spread through hands and shared items like towels, though most people exposed do not develop an infection. Wash your hands after touching your nose or applying ointment, and do not share towels or ointment tubes.

Can a nose infection be dangerous?

Rarely. Infections in the center of the face can spread through veins to the area behind the eye, causing cavernous sinus thrombosis. Warning signs include swelling around the eye, double vision, a bulging eye, high fever and severe headache. These need emergency care.