Management of Burning Nasal Lesion

Nasal saline irrigation is the first-line treatment for a burning nasal lesion, providing moisturization and symptom relief. 1, 2

Initial Assessment and Conservative Management

Nasal burning sensations may be associated with various conditions including rhinitis, sinusitis, or empty nose syndrome, requiring appropriate moisturization as primary treatment 1
Saline irrigation is recommended as first-line therapy to moisturize the nasal cavity, remove crusts, and provide symptomatic relief 2, 1
Regular irrigation 2-3 times daily with buffered hypertonic (3%-5%) saline may provide superior anti-inflammatory effect compared to isotonic saline 2
Nasal saline irrigation improves quality of life, decreases symptoms, and decreases medication use, particularly in patients with frequent sinus issues 2

Topical intranasal corticosteroids may be considered for burning nasal lesions with inflammatory components, though they should be used cautiously as they may worsen dryness in some cases 2, 1
Intranasal antihistamines may be considered as first-line treatment for allergic and nonallergic rhinitis that presents with nasal burning 2
For small superficial lesions, bacitracin ointment may be applied to the affected area 1-3 times daily in a small amount (equal to the surface area of a fingertip) 3
Avoid prolonged use (>3-5 days) of topical decongestants as they can cause rebound congestion and rhinitis medicamentosa, potentially worsening symptoms 2

Pain relief is a major goal in managing nasal conditions and often the main reason patients seek healthcare 2
Over-the-counter analgesics such as acetaminophen are usually sufficient to relieve facial pain associated with nasal conditions 2
Avoid NSAIDs like ibuprofen if there's any concern about bleeding from the lesion 2

If the burning lesion is associated with dryness, maintaining nasal humidity with saline sprays and moisturizing agents will prevent dry crusts and facilitate healing 2
For lesions suspected to be bacterial in nature, topical antibacterial therapy may be considered, though evidence suggests it may provide only clinically non-relevant improvement in symptoms compared to placebo 2
If the lesion is associated with recurrent staphylococcal infections, mupirocin nasal ointment has shown superior efficacy (95% eradication at 8 days) compared to chlorhexidine/neomycin cream (61% eradication) 4

If the burning nasal lesion persists despite conservative management, further evaluation should be considered to rule out premalignant or malignant conditions 5
Persistent symptoms beyond 10 days, worsening symptoms after initial improvement, or severe symptoms may indicate bacterial infection requiring additional treatment 2
Any lesion with concerning features (rapid growth, bleeding, ulceration) warrants prompt referral to a specialist for further evaluation 5

Avoid prolonged use of topical decongestants beyond 3-5 days due to risk of rebound congestion 2
Antihistamines may worsen congestion by drying the nasal mucosa in non-allergic patients 2
Systemic steroids should be used cautiously and only for short courses (5-7 days) in cases of very severe or intractable nasal symptoms 2
Antibiotics are not recommended for viral nasal conditions and do not directly relieve symptoms 2