Redness In or Around the Nose

Persistent redness around the nose: common causes

Rosacea

Rosacea is the most common cause of long-lasting redness on the nose and central face, especially in adults over 30 with fair skin. Features:

• flushing that comes and goes, then persistent redness over the nose, cheeks, chin and forehead
• visible small blood vessels (telangiectasia)
• red bumps and pus spots that look like acne but without blackheads
• burning or stinging skin, often sensitive to products
• in some people, mostly men, thickened, bumpy skin on the nose (rhinophyma)

Common triggers include sun, heat, alcohol, spicy food, hot drinks, stress and some skin products.

Seborrheic dermatitis

Seborrheic dermatitis causes red, flaky, sometimes greasy-looking patches in the creases beside the nose (the nasolabial folds), the eyebrows, behind the ears and on the scalp as dandruff. It is linked to a skin yeast called Malassezia. It flares in winter and with stress, and is common in people with Parkinson's disease or HIV. This is a frequent cause of a red and dry nose with flaking at the sides.

Chapping and irritation

Repeated nose blowing during a cold or allergy season strips the skin under and around the nostrils, leaving it red, raw and sometimes cracked. Cold, wind and dry indoor air make it worse.

Perioral and perinasal dermatitis

Perioral dermatitis causes small red bumps and scaling around the mouth, sides of the nose and sometimes the eyes, with a clear band of skin next to the lips. It is often triggered by steroid creams or inhalers and heavy face creams.

Acne and contact dermatitis

Acne causes red spots and blackheads on the nose. Contact dermatitis from glasses frames, masks, fragrances or skin care products causes itchy, red, sometimes scaly patches exactly where the product touched.

What causes redness inside the nose

• Nasal vestibulitis: infection of the skin just inside the nostril, usually by staph bacteria from picking, plucking nose hairs or frequent blowing. The nostril is red, crusty and sore.
• Nasal furuncle (boil): a tender, red, hot lump inside the nostril or on the tip.
• Dryness: dry winter air, oxygen tubing and decongestant sprays cause redness, crusting and nosebleeds.
• Allergic rhinitis: a pale or bluish but sometimes red, swollen lining with itching and sneezing.

Infections in the "danger triangle" between the bridge of the nose and the corners of the mouth can rarely spread to veins draining toward the brain. This is why a painful, spreading nose infection with fever should be seen promptly and should never be squeezed.

Less common causes

• Lupus: a butterfly-shaped rash across the cheeks and bridge of the nose that spares the folds beside the nose, often with joint pain, fatigue and mouth ulcers.
• Sunburn and sun damage: the nose is the most exposed part of the face.
• Broken capillaries: from sun damage, aging, alcohol or genetics.
• Skin cancer: basal cell carcinoma commonly appears on the nose as a pearly bump or a red, scaly patch that bleeds and does not heal.
• Cellulitis: a spreading, hot, painful redness with fever.
• Frostbite and cold injury.

Telling the causes apart

How it is diagnosed

A doctor or dermatologist can usually diagnose the cause by looking at the pattern of redness and asking about triggers, products, steroid use, sun exposure and other symptoms. A skin scraping, swab, biopsy, or blood tests for lupus are used when the diagnosis is unclear.

Red nose treatment

Home care

• Wash with a gentle, fragrance-free cleanser and lukewarm water.
• Use a bland moisturizer or petroleum jelly on chapped skin and inside dry nostrils.
• Use broad-spectrum sunscreen of SPF 30 or higher every day. Mineral sunscreens (zinc oxide) are often best tolerated.
• Keep a diary of flushing triggers and limit them.
• Use soft tissues and pat rather than rub when blowing your nose.
• Do not use steroid creams on the face unless a doctor recommends it. They can worsen rosacea and perioral dermatitis.

Medical treatment by cause

• Rosacea: creams such as metronidazole, azelaic acid or ivermectin, brimonidine or oxymetazoline gel for redness, oral doxycycline for bumps, and laser or intense pulsed light for visible vessels.
• Seborrheic dermatitis: antifungal creams such as ketoconazole, medicated shampoos, and short courses of mild anti-inflammatory creams.
• Perioral dermatitis: stopping steroid creams, then topical or oral antibiotics.
• Nasal vestibulitis: antibiotic ointment, and oral antibiotics for a boil or spreading infection.

Frequently asked questions

Why is the skin around my nose always red?

Persistent redness around the nose is most often rosacea or seborrheic dermatitis. Rosacea causes flushing, visible vessels and acne-like bumps. Seborrheic dermatitis causes flaky, greasy-looking redness in the creases beside the nose. A dermatologist can confirm which one and suggest treatment.

What causes redness inside the nose?

Redness inside the nostril usually comes from irritation or infection of the skin at the entrance, called nasal vestibulitis, often from picking or frequent blowing. Dry air, decongestant sprays and allergies also cause it. A painful, swelling lump suggests a boil.

How do I treat a red, dry nose?

Use a gentle cleanser, a thick fragrance-free moisturizer or petroleum jelly, and daily sunscreen. Avoid harsh scrubs and alcohol-based toners. If flaking persists, an antifungal cream for seborrheic dermatitis may help. See a doctor if it lasts more than a few weeks.

Can rosacea on the nose be cured?

There is no cure, but rosacea can be well controlled. Avoiding triggers, daily sun protection, prescription creams or tablets, and laser treatment for visible vessels reduce redness for most people.