nasal furuncle

Last edited 08/2023 and last reviewed 08/2023

Nasal furunculosis is a boil in the nasal vestibule as a result of infection of a hair follicle.

• characterized by an acute localized infection of the hair follicle in the skin lining of the nasal vestibule
• lesion/lesions are usually small and tender, commonly infected with staphylococcus aureusylococcus aureus
• presents as a tender swollen red nodules over the nasal tip, often with pustules
• can occur as a primary infection or secondary to chronic rhinorrhea, upper respiratory infections, and nose picking (2)

Treatment is usually conservative, including warm compressions applied to the area infected (1)

• in some cases topical/systemic antibiotics are used alongside simple analgesics
  • a common condition that can be managed conservatively or with intranasal topical mupirocin

The condition is serious because it carries a risk of the development of cavernous venous thrombosis:

• rare, complications include scarring, abscess development, ophthalmic vein thrombosis, cavernous sinus thrombosis, orbital abscess and progression to septal haematomas (as a result of abscess development) (1)

Note that patients may present/develop nasal vestibulular involvement:

• usually present with painful swelling in the vestibule (2)
  • skin over the nose becomes tense and red, and a boil may be visible in the nostril
  • if not treated properly, the patient can develop complications like facial cellulitis and cavernous sinus thrombosis, which is characterized by fever, headache, chemosis, proptosis, and cranial nerve III, IV, V, and VI palsies
  • patients with complications often require hospital admission, drainage of the boil, and intravenous antibiotics

Reference:

• Sheik-Ali S, Sheik-Ali S, Sheik-Ali A. Nasal vestibular furunculosis: Summarised case series. World J Otorhinolaryngol Head Neck Surg. 2022 May 23;8(3):217-223. doi: 10.1016/j.wjorl.2020.12.003. PMID: 36159901; PMCID: PMC9479471.
• Bakshi SS. Image Diagnosis: Nasal Furunculosis-A Dangerous Nose Infection. Perm J. 2018;22:17-076. doi: 10.7812/TPP/17-076. PMID: 29236652; PMCID: PMC5737918.