Treatment of Nasal Vestibulitis
Topical mupirocin ointment applied three times daily to the affected area is the first-line treatment for nasal vestibulitis, with clinical response expected within 3-5 days. 1
Primary Treatment Approach
Apply a small amount of mupirocin ointment to the affected nasal vestibule three times daily, as this topical antibiotic directly targets Staphylococcus aureus, the causative organism in over 80% of cases. 1, 2
The treated area may be covered with gauze dressing if desired, though this is optional based on patient comfort and severity. 1
Reassess patients who fail to show clinical response within 3-5 days, as this indicates either treatment failure or the need for alternative diagnosis. 1
Alternative and Adjunctive Therapies
Oral sodium fusidate can be added for more severe cases or when topical therapy alone is insufficient, particularly when there is significant swelling, erythema extending to the nasal tip (Rudolph sign), or vestibular abscess formation. 3, 4
Consider oral antibiotics covering MSSA (methicillin-sensitive S. aureus) if mid-facial cellulitis develops, which occurs in approximately 79% of hospitalized cases, though most cases are managed outpatically. 2
Topical basic fibroblast growth factor (bFGF) may accelerate mucosal healing, reducing healing time from approximately 36 days to 18 days when added to conventional treatment, though this is not standard first-line therapy. 5
Clinical Context and Risk Factors
The diagnosis is entirely clinical—no cultures or imaging are needed for uncomplicated cases. 6 Common precipitating factors include nasal hair plucking (14%), nose blowing (9%), nose picking (8%), and nose piercing (3%). 2 Diabetes and immunosuppression are present in a minority of cases but should prompt closer monitoring. 2
Expected Clinical Course
Most cases resolve within 7 days of appropriate topical antibiotic therapy. 3
Complications such as cavernous sinus thrombosis or ophthalmic vein thrombosis are extremely rare, even in cases severe enough to require hospital admission, but early recognition and treatment are essential to prevent these potentially serious sequelae. 2, 4
Vestibular abscess formation occurs in approximately 48% of more severe cases but typically responds to the same antibiotic regimen without requiring surgical drainage. 2
Critical Management Pitfalls
Do not confuse nasal vestibulitis with acute rhinosinusitis—vestibulitis is a localized skin/follicular infection at the nasal entrance, not sinus inflammation requiring different management. 6
Do not delay treatment in patients with diabetes or immunosuppression, as these populations may have higher risk for progression, though data remains limited. 2
Do not prescribe systemic antibiotics as first-line therapy for uncomplicated cases—topical mupirocin is sufficient and avoids unnecessary antibiotic exposure. 1, 6, 3