What is the treatment for a scratch inside the nose, possibly caused by dryness or allergies?

Treatment of Nasal Scratches

For a scratch inside the nose, apply nasal emollients or moisturizing ointments to promote healing and prevent further trauma, while avoiding picking or rubbing the area. 1

Immediate Management

• Apply topical emollients or ointments to the affected area, which are well-tolerated with minimal risks and help prevent rebleeding from the scratch site 1
• Use nasal saline sprays or humidification to keep the nasal mucosa moist and facilitate healing 1
• Avoid trauma to the healing area by refraining from nose picking, rubbing, or inserting objects into the nose 1

When Active Bleeding Occurs

If the scratch causes active bleeding:

• Apply topical vasoconstrictors such as oxymetazoline (Afrin) or phenylephrine on a cotton pledget or as a spray, which achieves bleeding control in 65-75% of patients 1
• Limit vasoconstrictor use to 3-5 days maximum to prevent rhinitis medicamentosa (rebound congestion) 1, 2
• After bleeding stops, transition to lubricants and moisturizing agents to prevent additional bleeding 1

Addressing Underlying Causes

If Dryness is the Primary Issue:

• Continue nasal saline irrigation as adjunctive therapy for chronic dryness symptoms 3, 4
• Use hyaluronic acid-based nasal sprays or isotonic saline sprays, which significantly improve dry nose symptoms and are well-tolerated 5
• Consider environmental humidification, particularly in dry climates or during winter months 1

If Allergic Rhinitis is Contributing:

• Start intranasal corticosteroids (fluticasone, mometasone, budesonide) if nasal inflammation and congestion are present, as these are first-line therapy for moderate to severe allergic rhinitis 1, 2
• Direct sprays away from the nasal septum to prevent further mucosal irritation and potential septal perforation 3, 2
• Add second-generation oral antihistamines (cetirizine, loratadine) if sneezing and itching are prominent symptoms 1, 2

Critical Pitfalls to Avoid

• Never use topical decongestants for more than 3-5 days, as prolonged use causes rhinitis medicamentosa and worsens nasal symptoms 1, 2, 6
• Avoid aggressive nose blowing or manipulation during the healing period, as this can disrupt healing and cause rebleeding 1
• Do not apply bilateral nasal cautery if cauterization becomes necessary, as this increases risk of septal perforation 1

When to Seek Further Evaluation

• If bleeding persists despite conservative measures or recurs frequently 1
• If there are signs of infection (purulent drainage, fever, increasing pain)
• If the scratch does not heal within 7-10 days with appropriate moisturization 1
• If underlying rhinitis symptoms are not controlled with over-the-counter therapy 2