Diagnosis of inflammatory diseases of the external part of the nose

Anna Morgacheva , Candidate of Medical Sciences, otolaryngologist, Department of Ear Microsurgery, OKB named after. I. I. Mechnikova (Dnepr)

Tatyana Svyatenko , State Institution DMA MZO of Ukraine, Center for Dermatology and Cosmetology of Professor Svyatenko (Dnepr)

From the point of view of aesthetic medicine, the nose, in addition to its physiological functions, has a very important aesthetic significance for the visual assessment of the face. And a beautiful nose is, first of all, a healthy nose with well-groomed skin. In dermatological practice, cases of disease in this area of the face are quite common, which significantly reduce not only the patient’s well-being, but also satisfaction with their appearance.

Let's talk about the most common cases of inflammatory diseases of the external part of the nose.

Folliculitis of the vestibular part of the nose (sycosis)

Folliculitis is an inflammation of one or more hair follicles and surrounding tissues, often of infectious origin (most often provoked by staphylococci, less often by fungi, viruses, parasites). The disease can be caused by pathogens that enter the skin of the nasal vestibule during chronic inflammatory diseases of the nose and paranasal sinuses, during shaving and other mechanical trauma.

Clinic: upon examination, you can see small, yellowish-white pustules, surrounded by areas of hyperemia and penetrated by hairs. Most often, the course of the disease is chronic, recurrent, as a result of which the area of the pathological process may increase, which involves an increasingly larger area of skin. The skin turns red, infiltration and pain appear. The pus released from the papules, flowing out, forms crusts, under which a weeping erosive surface is determined. Painful cracks appear in the vestibule of the nose. A patient with folliculitis can infect others if hygiene rules are not followed.

Diagnosis: Diagnosis is made based on medical history and examination. Laboratory analysis of the contents of the pustule allows one to distinguish bacterial folliculitis from fungal folliculitis. Bacterial folliculitis can resolve on its own, but more often has a recurrent course.

Therapy: Antibacterial agents are used for local treatment. Systemic antibiotics may be prescribed if the infection tends to spread. Antimycotic agents are used to treat fungal folliculitis.

A cosmetologist should be alert in cases where the disease is recurrent, the patient’s body temperature rises above 38, there is redness, pain, swelling of the surrounding tissues, enlarged lymph nodes, and new symptoms appear. With proper treatment, symptoms of bacterial folliculitis usually disappear after an average of two weeks. Fungal folliculitis usually resolves within six weeks. But recovery may be delayed in case of late diagnosis and inappropriate use of steroid creams.

Prevention of Recurrence: Any patient who tends to develop folliculitis should cleanse the skin with antibacterial soap twice a day and avoid using oil-based lotions before shaving. When shaving, people prone to folliculitis should use a new blade every day. It is necessary to take into account the fact that superficial staphylococcal folliculitis can transform into deep, spread to the tissue surrounding the follicle and lead to the formation of an abscess-boil. When several nearby boils merge, a carbuncle is formed (an acute purulent-necrotic inflammation of the skin and subcutaneous tissue around a group of hair follicles and sebaceous glands, which tends to spread rapidly). If the provoking factors are not eliminated, folliculitis recurs and can become chronic.

Differential diagnosis: Conducted with non-infectious inflammation of the hair follicles (acne vulgaris, rosacea, perioral dermatitis, eozonophilic folliculitis), trichophytosis, herpetic folliculitis, molluscum contagiosum; dermatitis caused by chemicals, keloids, ingrown hairs and others.

Nasal boil

A nasal boil is a purulent-necrotic inflammation of the hair follicle, sebaceous gland and fiber (photo 1).
It differs from folliculitis by the widespread involvement of surrounding tissues in the process. Nasal furuncle is a serious disease due to the structural features of the venous system of the face and the likelihood of developing thrombosis of the cavernous sinus, sepsis, as well as other complications - both intracranial and orbital.

Clinic: A nasal furuncle can be a manifestation of general furunculosis or a consequence of inflammatory processes in the nasal cavity and paranasal sinuses. As a rule, it is caused by staphylococcus. Predisposing factors to the development of a boil can be diabetes mellitus, dermatitis and eczema of the skin of the external nose, and a general decrease in immunity. Most often, the boil is localized on the tip, wings and vestibular part of the nose. First, redness of the skin and infiltration of soft tissues appear. Necrosis of soft tissues forms around the primary focus of inflammation, and the core of the boil is formed. The patient may experience increased body temperature, headache and other signs of intoxication. A few days after the onset of the disease, an abscess forms in the infiltration zone, pain and tension are sharply expressed. In the case of the formation of several purulent-necrotic rods (that is, a carbuncle), the disease is more severe.

Therapy: Treatment of boils is predominantly conservative. I would like to draw the specialist’s attention to special caution when manipulating the area of infiltration if it is located in the triangle between the nasolabial folds and the upper lip, since attempts to squeeze out the core of the boil in this area can lead to the rapid spread of infection along the venous bed, which can lead to severe complications. Patients are usually prescribed intensive antibacterial and detoxification therapy. Antibacterial ointments and physiotherapy are used locally.

Consultations with specialists: A patient with a nasal boil should be referred for consultation to an otolaryngologist, and if the process is widespread, changes in the appearance of the cheek, upper lip and eye, symptoms of intoxication, urgent hospitalization and observation by an otolaryngologist, ophthalmologist, neurosurgeon and resuscitator are necessary.

Erysipelas of the external nose

Erysipelas, or erysipelas, is one of the variants of streptococcal lesions of the skin and underlying tissues, accompanied by general inflammatory reactions of the body. This disease is of infectious origin, but its contagiousness is low. It usually develops as a result of infection with streptococcus, less often - with staphylococcus, of injured skin in the area of the vestibule of the nose. Often occurs after squeezing out festering acne or boils in the nasal area. Erysipelas can also occur as a complication after surgery in the area of the external nose and paranasal sinuses.

Clinic: The first days of the disease are usually accompanied by an increase in body temperature to febrile levels, chills, headache, and fever. Severe hyperemia and swelling appear on the skin of the external nose with a clear boundary from healthy areas in the form of a roller-like thickening. In the first days of the disease, regional lymphadenitis often occurs. In the bullous form, vesicles filled with inflammatory exudate appear against the background of brightly hyperemic skin.

Complications: A long-term and severe disease can lead to the spread of the inflammatory process to the face, scalp, chest, and also to the mucous membrane of the nasal cavity.

Therapy: Treatment of erysipelas is usually carried out in a hospital and includes the following set of measures:

• massive antibacterial therapy;

• treatment of affected areas of the skin with antiseptic solutions, emulsions, ointments (lotions from solutions of silver nitrate, rivanol, Burov's liquid, ectericide, syntomycin and streptocide ointments and emulsions);

• irradiation of affected skin areas with erythemal doses of ultrasound rays, laser therapy;

• treating the surrounding skin with alcohol.

Successful treatment of any diseases, including dermatological ones, is highly dependent on high-quality and timely diagnosis. It is also important to remember the principle of compliance when working with colleagues and judicious prescribing of therapy, especially when it comes to the need to use antibiotics.

A beautiful patient is, first of all, a healthy patient!

The full version of the article can be read in the publication Cosmetologist 2016, No. 1