What is the treatment for nasal vestibulitis?

Treatment of Nasal Vestibulitis

Topical mupirocin ointment applied three times daily is the first-line treatment for nasal vestibulitis, with patients typically showing clinical improvement within 3-5 days. 1, 2

Understanding Nasal Vestibulitis

• Nasal vestibulitis is an infection of the nasal vestibule, often characterized by erythema, swelling, and tenderness over the nasal tip 2
• The most common causative organism is Staphylococcus aureus, with MSSA (methicillin-sensitive S. aureus) being the most frequent isolate (81.25% of cases) 3
• Risk factors include nasal hair plucking (14.41%), frequent nose blowing (9.32%), nose picking (8.47%), and nose piercing (3.39%) 3

First-Line Treatment

• Apply a small amount of mupirocin ointment to the affected area three times daily 1
• The area may be covered with a gauze dressing if desired 1
• Patients should be re-evaluated if they do not show clinical response within 3-5 days 1
• Nasal vestibulitis typically clears within 7 days with appropriate treatment 2

Supportive Measures

• Nasal saline irrigation is recommended as a first-line adjunctive treatment to moisturize the nasal cavity, remove crusts, and provide symptomatic relief 4
• Regular irrigation 2-3 times daily with buffered hypertonic (3%-5%) saline may provide superior anti-inflammatory effects compared to isotonic saline 4
• Warm compresses can help relieve pain and promote drainage 5
• Over-the-counter analgesics such as acetaminophen are usually sufficient to relieve facial pain associated with nasal conditions 4

Additional Treatment Options

• For cases with inflammatory components, intranasal corticosteroids may be considered, though they should be used cautiously as they may worsen dryness in some cases 4
• Oral antibiotics may be necessary for more severe infections or when there is evidence of spreading infection (cellulitis) 2, 3
• A short course (5-7 days) of oral corticosteroids may be appropriate only for very severe or intractable cases 6

When to Consider Further Evaluation

• Persistent symptoms beyond 10 days 4
• Worsening symptoms after initial improvement 4
• Severe symptoms or evidence of complications such as cellulitis 3
• Mid-facial cellulitis was observed in the majority of hospitalized patients (78.81%), and abscess of the nasal vestibule was observed in almost half (48.30%) of severe cases 3

Pitfalls to Avoid

• Avoid prolonged use of topical decongestants (>3-5 days) as they can cause rebound congestion and rhinitis medicamentosa 4
• Systemic antibiotics should be reserved for cases with evidence of spreading infection 2
• Avoid NSAIDs if there's any concern about bleeding from the lesion 4
• Be aware that immunodeficiency can play a role in recurrent nasal vestibulitis, and patients with recurrent episodes may need evaluation for underlying conditions 5

Emerging Treatments

• Recombinant human basic fibroblast growth factor (bFGF) has shown promise in promoting mucosal healing and shortening healing time in nasal vestibulitis (18.3 ± 4.8 days vs. 36.2 ± 6.2 days with conventional treatment) 7
• Traditional treatments such as leech therapy (Jalaukāvacaraṇa) have been reported to reduce pain, swelling, and redness in some cases 5