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Conditions involving external nose
Dr T Balasubramanian
Importance of nose
Nose is the most prominent portion of face
More prone for injuries Disorders of external
nose could be a indicator of a systemic disorder
Introduction
Disorders of external nose commonly involves skin Whole of dorsum of nose is skin lined The vestibule of the nose is skin lined Since the common problems involve the skin in this
area a recap of dermatological terms is a must
Dermatological terms
Macule – This is a flat lesion within the skin Papule – Circumscribed raised lesion of dermis /
epidermis less than 1 cm in diameter Nodule – This is a papule greater than 1cm in
diameter Plaque – Is a large superficial lesion whose surface
area is greater than that of its height and its margins are irregular
Acute nasal infections
Bacterial – Vestibulitis, Erysepelas, and impetigo Viral – Herpes, Warts, Molluscum contagiosum,
Measles
Acute vestibulitis
Infection of nasal vestibular skin
Commonly arises from hair bearing region of vestibule
Staph aureus is the commonly involved organism
Common in children due to nose picking
Acute vestibulitis symptoms
Severe pain Fever Swelling Tenderness In recurrent vestibulitis diabetes to be ruled out
Vestibulitis treatment
Broad spectrum antibiotics Antiinflammatory drugs Local application of antibiotic cream Squeezing to be avoided – could cause cavernous
sinus thrombosis
Dangerous area of face
Infection can traverse via the valveless facial vein
Via its supraorbital and superior ophthalmic branches spread to cavernous sinus
Impetigo
Superficial contageous infection involving the skin of the vestibule
Group A streptococcus is involved Two forms bullous and non bullous forms Staphylococcal infection leads to widespread
shedding of epidermis (scalded skin syndrome / Lyell's disease)
Erysipelas
Acute infection of skin lined vestibule Streptococcus implicated It enters via fissures in the skin Pain, heat, swelling and vesiculation Peau d ' orange appearance
Herpes simplex lesions
Type I Herpes virus is involved Lips, perioral region and cheek involved Infections from this area spreads to involve the
vestibule of the nose Antibiotics help in preventing secondary infections
Herpes zoster lesions
This virus is responsible for chicken pox lesion Involvement of maxillary division of V nerve causes
vesicles over cheek and nasal vestibule areas Infection gets transmitted via fluid present in the
vesicles
HPV infections
Warts Localised neoplastic growth of epidermis Self limiting Cryotherapy / cauterization
Lesions formed by HPV
Warts Three types of lesions are possible Hyperkeratotic lesions, verruca vulgaris, common
wart All these lesions appear raised Usually self limiting
Wart Verruca vulgaris
Molluscum contagiosum
DNA virus of Pox group is involved Appears as small papules white and waxy with a
dome Not contagious Self limiting Can be cauerized
Chronic infections
Vestibulitis Lupus vulgaris Syphilis Lupus erythematosis Acne rosacea
Chronic vestibulitis
Repeated fissuring of vestibule Crust formation Epistaxis is possible when the pt rubs the nose Diabetes to be excluded
Lupus vulgaris
This is a type of cutaneous tuberculosis involving the skin of the vestibule
Direct inoculation of skin causes scrofuloderma Post primary tuberculosis Initially lesions are nodular resembling apple jelly
hence the term apple jelly nodules Extensive tissue destruction is seen causing nasal
deformities. Nasal cartilages are predominantly destroyed
Syphilis
Primary syphilis involving the vestibule is common Firm painless nodule Rubbery cervical adenopathy Rhinitis ”syphlitic snuffles” Secondary syphilis causes vestibular skin fissuring Tertiary syphilis in the form of gumma is common
in the nose. There is extensive bony destruction. Tenderness over bridge of nose & nocturnal pain
Congenital syphilis
Presents within few weeks after birth Purulent rhinorrhoea ”Snuffles” Fissuring around vestibule Saddling of nose is seen at the age of 3-4
Yaws
Extragenital infection of T Pertenue Common in children of Africa Extensive disease can lead to midfacial destruction Gondou type of yaws causing bilateral rounded
swelling of nasal process of maxilla
Lupus erythematosis
Autoimmune disorder Multi organ disorder Involves skin in the vestibule Photosensitivity
Acne rosacea
Involves the skin over the face Skin lining of the nasal vestibule is also involved Skin shows reddish patches with ruptured
subcutaneous blood vessels Nose becomes red and bulbous Burning / stinging sensation over face + Avoid exposure to sun
Neoplasms
Benign – Papilloma, Kerata acanthoma Malignant – Rodent ulcer, sq cell carcinoma
Keratoacanthoma
Benign tumor arising from hair follicles of skin over the nose
Skin exposed to sun causes more problems Presents are firm, round, reddish / flesh colored
lesion Lesion may turn globular and may present with a
horny central keratotic plug Shedding of this plug signals recovery
Traumatic conditions
Fracture nose Septal hematoma Saddle nose
Fracture nose
May be with or without displacement Deformity of dorsum of nose Tenderness / Swelling over nasal bone area /
crepitus X-ray nasal bones may reveal # Closed reduction is preferred
Septal hematoma / abscess
May be caused by injuries / surgery in the nasal septal area
Bilateral swelling of nasal septum with nasal block Perichondrium stripped away from the cartilage Cartilage necrosis occur within 36 hours if not
drained Hematoma may give rise to septal abscess
Saddle nose
Occurs due to destruction of the bridge of nose Destruction of osseous / cartilagenous portion of the
bridge of nose Septal abscess / syphilis involving the nose may
cause this problem
Foreign bodies
Inanimate Animate Rhinolith
Conditions involving nasal septum
Deviated nasal septum Dislocation of anterior portion of nasal septum Septal perforatrion
Congenital conditions
Nasal dermoid Gliomas Choanal atresia
Thankyou