Nasal vestibulitis is bacterial infection of the nasal vestibule, typically with Staphylococcus aureus. It may result from nose picking or excessive nose blowing (1). In some patients with cancer, nasal vestibulitis can occur as an adverse effect of epidermal growth factor receptor inhibitors (EGFRIs) and vascular endothelial growth factor (VEGF)-related therapies (2). It primarily causes annoying nasal crusts and bleeding when the crusts slough off. Erythema, swelling, and pain may also be present. Mupirocin ointment applied topically 2 times a day for 14 days is an effective treatment. Complications are rare.). It primarily causes annoying nasal crusts and bleeding when the crusts slough off. Erythema, swelling, and pain may also be present. Mupirocin ointment applied topically 2 times a day for 14 days is an effective treatment. Complications are rare.
Furuncles of the nasal vestibule are infections of the hair follicles (vibrissae) within the nasal vestibule. Infections are usually staphylococcal; if skin or nasal mucosa is colonized with Staphylococcus. aureus, there is a greater risk for recurrent folliculitis or furunculosis. Furuncles may develop into spreading cellulitis of the tip of the nose, sometimes referred to as the Rudolph sign. Systemic antistaphylococcal antibiotics (eg, cephalexin) may be given and warm compresses (3 times a day for 15 to 20 minutes at a time) and topical mupirocin can be applied., there is a greater risk for recurrent folliculitis or furunculosis. Furuncles may develop into spreading cellulitis of the tip of the nose, sometimes referred to as the Rudolph sign. Systemic antistaphylococcal antibiotics (eg, cephalexin) may be given and warm compresses (3 times a day for 15 to 20 minutes at a time) and topical mupirocin can be applied.
Treatment of furuncles caused by community-associated methicillin-resistant S. aureus (MRSA) should be directed by culture and sensitivity test results. Typically, clindamycin, (MRSA) should be directed by culture and sensitivity test results. Typically, clindamycin,trimethoprim/sulfamethoxazole, and doxycycline are effective against most strains (, and doxycycline are effective against most strains (3). Furuncles can be incised and drained to prevent local thrombophlebitis and subsequent cavernous sinus thrombosis.
References
1. Lipschitz N, Yakirevitch A, Sagiv D, et al. Nasal vestibulitis: etiology, risk factors, and clinical characteristics: A retrospective study of 118 cases. Diagn Microbiol Infect Dis. 2017;89(2):131-134. doi:10.1016/j.diagmicrobio.2017.06.007
2. Cathcart-Rake E, Smith D, Zahrieh D, et al. Nasal vestibulitis: an under-recognized and under-treated side effect of cancer treatment?. Support Care Cancer. 2018;26(11):3909-3914. doi:10.1007/s00520-018-4261-7
3. Stryjewski ME, Chambers HF. Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008;46 Suppl 5:S368-S377. doi:10.1086/533593