The area inside your nostrils that makes its way toward the nasal cavity is called the nasal vestibule. It is filled with tiny nose hairs that are responsible for the filtration of dust particles before the air enters the lungs. When the nasal vestibule gets infected, it can result in various symptoms.
Nasal vestibulitis is a bacterial inflammatory disease of the nasal vestibule primarily caused by Staphylococcus aureus. Although it is easy to treat nasal infections, they can lead to severe complications if not addressed properly. It is therefore important to know the symptoms, to determine the cause through diagnosis in order to properly manage nasal vestibulitis.1
Staphylococcus aureus are skin and mucosa-friendly bacteria that get easily attracted to the human body. Infections caused by S. aureus can be asymptomatic but most frequently result in severe complications for human health. The most common entry site for these bacteria is the human nose.2
Causes of nasal vestibulitis
A study identified that nasal vestibulitis can be the result of targeted therapies in cancer patients.3
Some of the common risk factors for nasal vestibulitis are minor traumas that result from your daily activities, for instance:
- Plucking nasal hairs
- Forceful nose blowing
- Nose piercing
- Picking the nose
Other fundamental risk factors can be:
- A runny nose due to allergic rhinitis or a common cold
- Infections of the upper respiratory tract
- Immunocompromised patients
- Herpes simplex and herpes zoster (shingles)
Signs and symptoms of nasal vestibulitis
The signs and symptoms of nasal vestibulitis vary according to its severity. Commonly it is characterised by redness and swelling of the nasal vestibule which sometimes covers your nostrils too. You may also experience unbearable pain and tenderness due to the inflammation.1
You may also get a fever, which is a sign that your immune system is fighting off the bacteria.1
Other signs that your physician may find during the clinical investigation are:
- Thick yellow crusting in and around the nose
- Elevated white blood cell count
- Inflammation of hair follicles
- Bumps (pimples) inside the nose
Diagnosis of nasal vestibulitis
You can diagnose nasal vestibulitis based on its physical presentation, however, it is essential to visit a doctor for a thorough clinical examination.
Your doctor may use medical instruments to check inside your nose for any complications and should suggest some immediate and effective treatment options to help your recovery.
Some diagnostic tests like nasal swabs (nasal cultures) and whole blood counts may be employed to aid diagnosis.4
Management and treatment for nasal vestibulitis
Treatments for nasal vestibulitis will depend on the severity of your condition and your doctor should be able to recommend the best course of action.
Most mild cases are managed with things such as:
- Warm compressions (cloths/heat packs)
- Pain relieving medications
- Topical antibiotic ointment applied to the nostrils (dose and length of treatment determined by your doctor as it is only available on prescription)5
Oral antibiotics should be prescribed in cases that present with a fever and severe cases that involve symptoms like facial cellulitis. If an abscess is formed, it may require drainage at the hospital.1
Rose geranium in sesame oil nasal spray has been researched to alleviate symptoms of nasal vestibulitis, especially for patients who have received cancer-targeted therapies.6 Rose geranium is known to have anti-inflammatory properties that reduce swelling and it is less harmful than prescribed medications.
Complications of nasal vestibulitis
Late diagnosis or inappropriate treatment of nasal vestibulitis can lead to some serious complications…
Cellulitis occurs when the infection spreads to the inner layers of skin (dermis and subcutaneous tissues) which, if left untreated, can extend to lymph nodes and the bloodstream causing life-threatening conditions.7
Nasal cellulitis can also cause other facial symptoms such as:
- Warm skin
- Pain and tenderness
- Fever (in case of systemic inflammation).
If you experience any signs of nasal cellulitis you should receive emergency medical care to prevent any further complications or worsening of health.
Complicated nasal vestibulitis can also affect your brain as most of the veins are connected to these parts of the body. Cavernous sinus thrombosis occurs when blood clots in the cavernous sinuses that are present towards the base of your brain. Blood clotting in these sinuses can lead to a life-threatening condition which is usually treated with intravenous (IV) antibiotics.
Common manifestations of this disease are:
- A “picket fence” fever
- Increased heart rate
- Low blood pressure
- Physical and mental lethargy
- Seizures (rare)
- Periorbital swelling, ptosis and redness of the eye
- Painful eye movements
- Blindness (serious cases)8
To prevent the complications of nasal vestibulitis, it is important to recognise the signs as early as possible and in case of uncertainties, the doctor should be consulted.
If you’re diagnosed with mild nasal vestibulitis, you should take care of the infected site, take medications as prescribed and follow other instructions specified by your physician.
Can nasal vestibulitis be prevented
There is minimal evidence on the prevention of nasal vestibulitis however, it is possible to reduce the risk by practising good nasal hygiene to prevent a potential S. aureus infection in your nose.
Complications of nasal vestibulitis are preventable if a proper care and treatment regimen is followed.
How common is nasal vestibulitis
Mild nasal vestibulitis is a common disorder mostly seen in children because of their tendency to pick and blow their noses, however, adults may get affected too.
Who is at risk of nasal vestibulitis
You are more likely to get affected by this bacterial infection if you:
- Have a weakened immune system
- Have been diagnosed with diabetes
- Have been treated with cancer therapies
- Perform high-risk activities on a regular basis
When should I see a doctor
You should consult with a doctor if:
- There is excessive facial redness and swelling which starts oozing
- You feel unbearable headaches and fatigue
- You have a fever that does not go away even after oral antibiotics
Nasal vestibulitis is a bacterial infection caused by Staphylococcus aureus. The risk factors for bacterial entry into your nose remain high due to plucking, blowing, and picking of your nose, thus it is recommended to avoid these actions to prevent the development of nasal vestibulitis. In the case of mild nasal vestibulitis, it is recommended to seek and follow your doctor’s advice to prevent any complications and aid a full recovery.
- Lipschitz N, Yakirevitch A, Sagiv D, Migirov L, Talmi YP, Wolf M, et al. Nasal vestibulitis: etiology, risk factors, and clinical characteristics. Diagnostic Microbiology and Infectious Disease [Internet]. 2017 Oct [cited 2023 Apr 4];89(2):131–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0732889317301840
- Sakr A, Brégeon F, Mège JL, Rolain JM, Blin O. Staphylococcus aureus nasal colonization: an update on mechanisms, epidemiology, risk factors, and subsequent infections. Front Microbiol [Internet]. 2018 Oct 8 [cited 2023 Apr 4];9:2419. Available from: https://www.frontiersin.org/article/10.3389/fmicb.2018.02419/full
- Ruiz JN, Belum VR, Boers-Doets CB, Kamboj M, Babady NE, Tang YW, et al. Nasal vestibulitis due to targeted therapies in cancer patients. Support Care Cancer [Internet]. 2015 Aug [cited 2023 Apr 7];23(8):2391–8. Available from: http://link.springer.com/10.1007/s00520-014-2580-x
- Marra P, Colacurcio V, Luca PD, Bisogno A, Calvanese M, Scarpa A, et al. Nasal Vestibulitis and Vestibular Furunculosis: a systematic review about two common nasal infections and considerations about correct diagnosis and management: doi: 10.7417/CT.2022.2487. La Clinica Terapeutica [Internet]. 2022 Nov 15 [cited 2023 Apr 7];173(6). Available from: https://www.clinicaterapeutica.it/ojs/index.php/1/article/view/648
- Mohamed-Yassin M, Mohamad-Isa M, Baharudin N. A red and swollen nose. Malays Fam Physician [Internet]. 2020 Mar 18 [cited 2023 Apr 7];15(1):61–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136680/
- Cathcart-Rake EJ, Smith D, Zahrieh D, Loprinzi CL. Rose geranium in sesame oil nasal spray: a treatment for nasal vestibulitis? BMJ Support & Palliative Care [Internet]. 2020 Dec [cited 2023 Apr 7];10(4):411–3. Available from: https://spcare.bmj.com/lookup/doi/10.1136/bmjspcare-2018-001569
- Sullivan T, de Barra E. Diagnosis and management of cellulitis. Clin Med (Lond) [Internet]. 2018 Apr [cited 2023 Apr 9];18(2):160–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303460/
- Plewa MC, Tadi P, Gupta M. Cavernous sinus thrombosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448177/