Nasal furuncle

A nasal furuncle is an acute purulent inflammation of the hair follicle and sebaceous gland of the outer or inner surface of the wing of the nose, the tip of the nose, or the cutaneous part of the nasal septum. Furuncles are most often located on the tip and wings of the nose, in the vestibule, near the nasal septum. Acute purulent-necrotic inflammation of several hair follicles and sebaceous glands with extensive necrosis of the skin and subcutaneous tissue of the nose is called a carbuncle.

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Epidemiology

Furuncle (carbuncle) of the nose is one of the private manifestations of pyoderma - a large group of acute and chronic, superficial and deep purulent-inflammatory processes of the skin, the specific weight of which in the structure of skin diseases is 40%. Patients with furuncles and carbuncles of the face make up from 4 to 17% of the total number of hospitalized in specialized departments during the year. Recently, an increase in the number of hospitalized with a diagnosis of furuncle (carbuncle) of the nose has been noted.

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Causes nasal furuncle

Staphylococci play a leading role in the development of a furuncle (carbuncle) of the nose: St. aureus. St. epidermidis (opportunistic), St. saprophyticus. distinguished by their ability to adhere and penetrate the skin, as well as resistance to phagocytosis. The etiological role of Staphylococcus aureus is associated with the high prevalence of carriage of this microbe - the proportion of people in whom St. aureus is constantly found on the skin of the wings of the nose and some other parts of the body (armpits, groin area) reaches 40%. Epidermal staphylococcus colonizes almost the entire skin, however, with the exception of the ability to adhere, this microbe does not have other virulence factors, and therefore its role in the development of a furuncle of the nose is less significant. The etiological significance of epidermal staphylococcus increases after surgical interventions, especially those associated with endoprosthetics and the use of various implants.

In addition to staphylococci, pustular skin diseases, in particular furuncle of the nose, can be caused by streptococci, mainly beta-hemolytic streptococcus group A, which is also the causative agent of tonsillopharyngitis, scarlet fever, sepsis, glomerulonephritis, rheumatism, erysipelas. Other groups of streptococci (green, non-hemolytic) play a less significant etiologic role in furuncle of the nose and other pustular skin diseases.

Pathogenesis

The occurrence and development of a furuncle of the nose is largely determined, on the one hand, by the pathogenicity and virulence of the pathogens, and on the other hand, by a combination of various exogenous and endogenous factors that form a predisposition to the development of a purulent process. The entry point for infection is usually a violation of the integrity of the skin of the vestibule of the nasal cavity and the external nose, which occurs with microtrauma (maceration, scratching); skin contamination (neglect of elementary hygienic rules of daily facial skin care, exposure to industrial factors: coal, cement industrial dust, fuels and lubricants). In addition, the occurrence of a furuncle of the nose can be facilitated by hypothermia or over-combing, which negatively affects the anti-infective resistance of the skin.

A significant role in the pathogenesis of nasal furuncle is played by various endogenous factors, accompanied by a decrease in the bactericidal properties of sweat and sebaceous gland secretion, and a violation of the functional activity of the immune system. The listed violations lead to the persistence of the pathogen on the skin surface, the formation of staphylococcal carriage, the occurrence and recurrence of nasal furuncles, as well as other localizations. In this regard, genetically determined conditions accompanied by immune deficiency, endocrine diseases, primarily diabetes mellitus, hypovitaminosis, poor nutrition, diseases of the digestive system, etc. have an extremely unfavorable effect on the incidence, course and prognosis of nasal furuncle.

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Symptoms nasal furuncle

Furuncle is most often located on the tip and wings of the nose, in the vestibule of the nasal cavity, on the cutaneous part of the nasal septum. In most cases, a gradual development of the inflammatory process is observed, which is initially localized in the mouth of the hair follicle (ostiofolliculitis), then spreading deeper. Within 1-2 days, compaction, hyperemia, swelling of the skin are formed here, pain appears, increasing with tension of the facial muscles, chewing, examination of the nose (with anterior rhinoscopy). The listed changes are accompanied by headache, weakness, and an increase in body temperature. From the side of the peripheral blood, as a rule, a shift in the leukocyte formula to the left, an increase in ESR are observed.

Later, if the process proceeds favorably, within 2-4 days the tissue density in the inflammation focus decreases, softening occurs in the center of the infiltrate, a small amount of pus is released, the necrotic core is rejected, and the remaining cavity of the abscess is quickly cleared and filled with granulations. As a rule, this is accompanied by a decrease in the intensity of pain, normalization of body temperature, and an improvement in the general condition.

In some cases, abscessing of the furuncle may occur - progression of purulent-inflammatory changes, increase in the area of tissue necrosis, thinning of the skin, and the appearance of fluctuation.

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Stages

A nasal furuncle is one of the manifestations of staphylococcal pyoderma, which include ostiofolliculitis, sycosis, deep folliculitis, hidradenitis, multiple abscesses in children, and pemphigus in newborns. In the development of a nasal furuncle, as well as any acute purulent-necrotic inflammation of the hair follicle and surrounding tissues, two stages are usually distinguished:

• Stage I infiltration - local pain, hyperemia of the skin, the presence of a dense infiltrate with a necrotic point in the center;
• Stage II of abscess formation - necrotic tissue melting in the inflammation site, thinning of the skin and fluctuation in the center of the infiltrate.

Complications and consequences

Characteristic signs of complicated nasal furuncle are symptoms of phlebitis of facial veins: pain, compaction and sometimes redness along the affected vessel, swelling of the upper and lower eyelids, soft tissues of the infraorbital region, forehead, increased body temperature to 38.5 C and above, shaking chills, weakness. When septic thrombosis of the venous sinus occurs, a violent infectious syndrome develops with high temperature, chills, sweating. In typical cases, circulatory disorders are observed (pastosity, swelling of the periorbital region, injections of conjunctival veins, chemosis, exophthalmos, congestive changes in the fundus).

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Diagnostics nasal furuncle

The diagnosis of a nasal furuncle is usually not difficult and is based on the results of the analysis of complaints, anamnestic information (pain in the area of localization of the purulent-inflammatory focus, headache, malaise), examination data (external examination of the nose, anterior rhinoscopy) - hyperemia, edematous infiltrative changes in the soft tissues of the external nose, vestibule of the nasal cavity, nasolabial tract.

When examining patients with a furuncle of the nose, one should keep in mind the high probability of developing septicemia and (or) septicopyemia. To a large extent, this is due to the extensive network of anastomoses between the superficial and deep vessels of the facial area located above the line connecting the earlobe and the corner of the mouth. In addition, there is the so-called dangerous triangle - the facial area limited by the lines connecting the midpoint of the frontal-nasal suture (nasion) with the corners of the mouth. The outflow of venous blood from these anatomical zones is carried out through the angular vein, the internal orbital vein into the cavernous sinus. This circumstance creates real prerequisites for the spread of infection not only to adjacent anatomical zones: eyelids, orbit, but also the base of the skull, intracranial veins and sinuses.

Neutrophilic leukocytosis and increased ESR are detected in peripheral blood.

Indications for consultation with other specialists

Indications for consultation with other specialists (neurologist, neurosurgeon, ophthalmologist, endocrinologist, etc.): complicated course of a nasal furuncle, the presence of pathogenetically related diseases in the patient (diabetes mellitus, etc.) requiring special treatment.

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Treatment nasal furuncle

The goal of treating a furuncle (carbuncle) of the nose is to regress local inflammatory changes, normalize the general condition of the patient, and restore working capacity.

Indications for hospitalization

The presence of a nasal furuncle is an indication for hospitalization of the patient.

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Non-drug treatment

When the body temperature rises, bed rest, liquid nutrition, and limitation of movements of the facial muscles are prescribed. Physiotherapeutic methods of influence have an anti-inflammatory and analgesic effect: sollux, UHF.

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Drug treatment

The nature of the treatment of a nasal furuncle depends on the stage of the inflammatory process. At the initial stage of the process (infiltration stage), careful wiping of the skin around the inflammation site with a 70% solution of ethyl alcohol or a 2% solution of salicylic alcohol is indicated. In the first hours after the appearance of the infiltrate, repeated lubrication of the pustule with 5% iodine tincture has a good effect.

Local antibacterial therapy consists of the use of fueidic acid (2% ointment), mupirocin (2% ointment).

The drugs of choice for systemic antibiotic therapy are cephalexin, oxacillin; alternative drugs are cephaleolin, amoxicillin-clavulanic acid, vancomycin, linezolid.

Surgical treatment

Surgical treatment is indicated when a furuncle abscesses. The formed abscess is opened under local infiltration anesthesia or under general (intravenous) anesthesia. An incision is made through the center of the inflammatory infiltrate, the edges of the abscess cavity are expanded with a mosquito-type hemostatic clamp or another similar instrument. When a furuncle abscesses and when there are pronounced reactive phenomena from the adjacent tissues, a counter-opening is applied. In order to prevent iatrogenic aesthetic disorders, when making incisions in the area of the external nose, one should focus on the natural folds of the skin, and when opening an abscess of the vestibule of the nasal reservoir, one should avoid damaging the edges of the nostrils. After the evacuation of pus and detritus, drainage (a strip of rubber glove) is inserted into the cavity, an aseptic dressing is applied, or the vestibule of the nose is loosely tamponed with a hypertonic solution (10% sodium chloride solution) or antiseptic solutions.

Approximate periods of incapacity for work in the case of uncomplicated disease are 7-10 days, in the presence of septic complications - up to 20 days or more.

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Further management

In case of recurrent nasal furuncles, a clinical and immunological examination and consultation with an endocrinologist are indicated. Recommendations for patients should contain information about the inadmissibility of massaging the area of inflammation, attempts to squeeze out the contents of the furuncle, and self-medication.

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Prevention

Primary prevention of furuncle (carbuncle) of the nose, as well as other purulent-inflammatory skin diseases, consists in preventing microtraumas and infection of the skin of the nose. Of great importance is the implementation of sanitary and hygienic measures aimed at reducing the pollution of industrial and domestic premises, compliance with personal hygiene rules, systematic use of detergents, creams for facial skin care.

Secondary prevention of furuncle (carbuncle) of the nose is a set of measures aimed at preventing recurrence of furuncle of the nose and (or) its complications in individuals at risk. First of all, we are talking about patients with pustular skin diseases (pyoderma) of the nose and nasal vestibule (folliculitis, sycosis), patients with diabetes mellitus, immunodeficiency states of various origins. An extremely important role is played by medical examination, systematic medical examinations, the level of awareness of patients about the causes and clinical manifestations of furuncle of the nose, possible complications of this disease, the need for consultation with an otolaryngologist to decide on further treatment. Of particular importance in this regard is the timely elimination of foci of chronic infection (caries, tonsillitis, sinusitis), correction of existing changes in carbohydrate metabolism, immune deficiency and other systemic disorders.

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Forecast

The prognosis for an uncomplicated course and adequate treatment is favorable. In the presence of complications, concomitant diseases, the prognosis is determined by the prevalence of the process and the severity of the condition, the timeliness and adequacy of treatment measures, the degree of compensation for concomitant diseases.