Treatment of Nasal Ulcers in Diabetes Mellitus
The treatment of nasal ulcers in diabetes mellitus should focus on wound moisturization with saline solutions, infection control with appropriate antibiotics, and optimal glycemic control as the foundation of therapy. 1, 2
Pathophysiology and Presentation
Diabetic patients are prone to nasal mucosal changes due to:
- Diabetic microangiopathy affecting nasal blood vessels
- Neuropathy affecting mucosal sensation
- Increased susceptibility to infections
- Impaired wound healing
Common presentations include:
- Xeromycteria (dry nasal mucosa)
- Hyposmia (decreased sense of smell)
- Decreased nasal patency
- Chronic atrophic rhinitis
- Septal perforation
- Mucosal ulceration
- Alar necrosis 2
Treatment Algorithm
1. Wound Care and Moisturization
- Gently irrigate the nasal ulcer with warmed sterile saline solution 1
- Avoid preparations containing sensitizers or irritants that may further damage the mucosa 1
- Apply non-adherent dressings that extend beyond wound margins if appropriate 1
- Use solutions to moisten the nasal mucosa regularly to prevent dryness 2
2. Infection Management
- Obtain cultures before starting antibiotics if signs of infection are present 1
- For superficial infections, start empiric antibiotics targeting Staphylococcus aureus and streptococci 1
- For deeper or more severe infections, use broad-spectrum antibiotics 1
- Adjust antibiotic therapy based on culture results and clinical response 1
- Be vigilant for fungal infections, which are more common in diabetic patients 2, 5
3. Glycemic Control
- Optimize diabetes management as poor glycemic control impairs wound healing 1
- Monitor HbA1c levels, as elevated levels are associated with increased S. aureus nasal colonization 4
- Implement appropriate insulin or oral hypoglycemic therapy to maintain target blood glucose levels 5
4. Debridement
- Consider sharp debridement of necrotic tissue if present, following principles similar to diabetic foot ulcer management 1
- Debridement should be performed based on clinical need rather than arbitrary schedules 1
Special Considerations
Complications to Monitor
- Nasal septal abscess formation, which can occur even weeks after nasal procedures in diabetic patients 6
- Progression to deeper tissue infection
- Necrosis of surrounding tissues
Preventive Measures
- Regular nasal examination in diabetic patients
- Early intervention for minor nasal lesions
- Patient education on proper nasal hygiene
- Prompt medical attention for any nasal symptoms 1
Pitfalls to Avoid
- Delaying treatment of nasal infections in diabetic patients, as they can progress rapidly
- Failing to screen for S. aureus nasal carriage, which is strongly associated with diabetic wound infections 3, 4
- Using irritating topical agents that may worsen mucosal damage 1
- Neglecting glycemic control, which is fundamental to wound healing 4
- Underestimating the risk of fungal infections in diabetic patients 2, 5