Nasal Vestibular Folliculitis (Nasal Furuncles)
The pimples inside your nose are most likely nasal furuncles (folliculitis), which are inflammatory nodules with overlying pustules caused by Staphylococcus aureus infection of hair follicles in the nasal vestibule. 1
Immediate Management
For small furuncles, apply moist heat to promote drainage—this is often sufficient as sole therapy. 1 Larger lesions require incision and drainage. 1
- Systemic antibiotics are usually unnecessary unless extensive surrounding cellulitis or fever develops. 1
- If antibiotics are needed due to surrounding cellulitis, the choice should account for local MRSA prevalence patterns 1
Understanding the Underlying Problem
The root cause is S. aureus colonization of your anterior nares (nasal vestibule). 1 Approximately 20-40% of the general population carries S. aureus in their nose, but only some carriers develop recurrent skin infections. 1, 2, 3
- Nasal carriage serves as a reservoir for repeated infections 1, 2
- The bacteria can colonize damaged skin barriers and cause follicular inflammation 2
Prevention of Recurrent Episodes
If you experience repeated nasal furuncles, the most effective strategy is eradicating nasal S. aureus carriage with topical mupirocin ointment applied twice daily to the anterior nares for the first 5 days of each month—this reduces recurrences by approximately 50%. 1
For more aggressive suppression:
- Oral clindamycin 150 mg once daily for 3 months decreases subsequent infections by approximately 80% (for clindamycin-susceptible strains). 1
- Mupirocin is significantly more effective than bacitracin for eradicating nasal S. aureus (94% vs 44% eradication rate). 4
Additional Preventive Measures for Outbreak Control
If multiple household members are affected or you have repeated episodes: 1
- Bathe with chlorhexidine antibacterial soap
- Thoroughly launder clothing, towels, and bedwear
- Use separate towels and washcloths
- Attempt eradication of staphylococcal carriage among all colonized household members
Critical Pitfalls to Avoid
Do not squeeze or manipulate nasal furuncles aggressively—the nasal vestibule has venous drainage to the cavernous sinus, and manipulation can theoretically lead to serious complications, though this is rare. 1
Avoid assuming this is acne—while S. aureus colonization rates are similar in acne patients and healthy controls (21.7% vs 26.6%), nasal vestibular lesions with pustules emerging through hair follicles are characteristic of folliculitis/furuncles, not acne. 5
When to Seek Urgent Care
Seek immediate medical attention if you develop: 1
- Fever
- Extensive surrounding redness or cellulitis spreading beyond the immediate area
- Facial swelling
- Vision changes or eye symptoms
- Severe headache
These could indicate deeper infection requiring systemic antibiotics or more aggressive intervention.