Nasal vestibular furunculosis

Etiology

  • Almost always Staph.aureus

Pathogenesis

  • Follicle infection within nasal vestibule.
  • The infection may spread through underlying tissue layers – seen as nasal erythema (Rudolf sign)

Risk factor

  • Maybe related to nasal hair trimming/plucking?

Signs and symptoms

  • Initially pain in tissue overlying the affected nasal vestibule when palpated without skin changes.
  • Later, the painful focus becomes reddened (Rudolf sign)
  • Pustules or abscesses are rare. Systemic symptoms are often absent
  • Often recur in patients having the condition before. maybe related to the fact that most of them are S.aureus carrier in the nose. Nose plucking exposes the follicle to the bacteria.

Diagnosis

  • Typical clinical features

Management

  • Topical antibiotics
    – Initially triple antibiotics oilment (PNB – Polymyxin, Neomycin & Bacitracin) is effective.
    – For some, resistance appears so topical mupirocin or retapamulin should be used.
  • Typically improves quickly after initiation of topical abx twice daily applied using a cotton tip to the entire area of the affected nasal vestibule.  The oilment should be continued for 2-3 days.

Reference:

Kevin W Dahle. The Rudolf Sign of nasal vestibular furunculosis: questions raised by this common but under-recognized nasal mucocutaneous disorder. Dermatology Online Journal 18(3):6

 

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