A nasal furuncle refers to a localized acute purulent inflammation of the hair follicle, sebaceous gland, or sweat gland in the nasal vestibule, nasal tip, or nasal ala, with the nasal vestibule being the most commonly affected site.
Etiology
This condition often results from damage to the accessory structures of the nasal vestibule or external nasal skin caused by actions such as nose-picking, plucking nasal hairs, or trauma, leading to secondary bacterial infection. Staphylococcus aureus is the primary causative pathogen, and the condition may also develop secondary to nasal vestibulitis. Individuals with low immunity, such as those with diabetes or undergoing chemotherapy, are more susceptible to this condition.
Clinical Manifestations
The skin of the nasal tip and alae is directly connected to the perichondrium without underlying subcutaneous tissue. As a result, furuncle formation in this area is associated with severe pain. Symptoms include localized redness, swelling, warmth, pain, and a focal elevated area. These may be accompanied by mild fever and generalized discomfort. Enlarged and tender submandibular or submental lymph nodes may also be present. Within approximately one week, as the furuncle matures, a yellow-white pustule may appear at the top, which spontaneously ruptures, releasing pus and resulting in resolution.
If improperly managed, the inflammation may spread to surrounding tissues, leading to complications such as cellulitis of the upper lip and cheek, characterized by redness, swelling, pain, and warmth in the corresponding regions, including the ipsilateral lip, cheek, and upper eyelid.
Diagnosis and Differential Diagnosis
Diagnosis is typically straightforward based on clinical signs and symptoms. However, differentiation from the following conditions is necessary:
- Nasal Vestibulitis: As detailed in the description of nasal vestibulitis.
- Erysipelas of the Nose: Caused by Group B hemolytic streptococci, this condition presents as rapid spreading skin redness and swelling, with a distinct boundary between the affected and normal skin. When compressed, the erythematous patches may take on a characteristic butterfly-shaped appearance. Unlike nasal furuncle, erysipelas generally does not involve nasal symptoms, making differential diagnosis relatively simple.
Complications
Perichondritis of the Nasal Ala or Nasal Tip
This occurs when the inflammation spreads to deeper layers, involving the perichondrium.
Cellulitis of the Cheek or Upper Lip
This indicates that the infection has extended to surrounding areas, with a high risk of concurrent cavernous sinus infections.
Orbital Cellulitis
Cavernous Sinus Thrombophlebitis
This is the most severe intracranial complication of nasal furuncle and often results from squeezing the furuncle, which can lead to the spread of infection through the angular vein and superior or inferior ophthalmic veins into the cavernous sinus. Clinical manifestations include chills, high fever, severe headache, eyelid and conjunctival edema on the affected side, proptosis, restriction of eye movement, optic disc edema, and even vision loss. Severe cases may be life-threatening.
Treatment
The treatment principles include avoiding squeezing the furuncle, controlling infection, and preventing complications.
Local Treatment
For unmatured furuncles, cleaning of the skin and the application of antibiotic ointments may be used, along with physiotherapy.
For matured furuncles, allowing the furuncle to rupture spontaneously or promoting rupture under sterile conditions can facilitate drainage. This can involve using a small probe to puncture the pustule, removing the core with small forceps or suction, or using a pointed blade to make an incision without extending into surrounding infiltrated tissue. Squeezing the furuncle is strictly prohibited.
For ruptured furuncles, local cleaning and disinfection help promote drainage. Application of antibiotic ointments to the rupture site can protect the wound, prevent scab formation, reduce inflammation, and promote healing.
Systemic Treatment
For patients with severe infections or compromised immunity, systemic antibiotic therapy may be administered. In cases with cavernous sinus involvement, sufficient antibiotics are essential. Ophthalmology or neurology consultation can assist with treatment when necessary.