Furuncle of the nose

Nasal furuncle - 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, the skin of the nasal septum. Boils are most often located on the tip and wings of the nose, on the eve, near the nasal septum. Acute purulent-necrotic inflammation of several hair sacs and sebaceous glands with extensive necrosis of the skin and subcutaneous tissue of the nose is called the carbuncle.

[1], [2]

Epidemiology

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

[3], [4], [5], [6], [7], [8]

Causes of the nose boil

In the occurrence of the furuncle (carbuncle) of the nose, staphylococci play the leading role: St. Aureus. St. Epidermidis (conditional pathogenic), St saprophyticus. Characterized by their ability to adhere and penetrate the skin, as well as resistance to phagocytosis. The etiological role of Staphylococcus aureus is associated with a high prevalence of carriage of this microbe - the proportion of persons in whom St. Aureus is constantly found on the skin of the wings of the nose and some other parts of the body (axilla, inguinal region) reaches 40%. Epidermal staphylococcus colonizes almost all of the skin, however, with the exception of its ability to adhere, this microbe does not have other virulence factors, and therefore its role in the development of the nose furuncle is less significant. The etiological importance of epidermal staphylococcus increases after surgical interventions, especially those associated with endoprosthetics, using a variety of implants.

In addition to staphylococci, pustular skin diseases, particularly nasal furuncle, can cause streptococci, mainly - group A beta-hemolytic streptococcus, which is also the causative agent of toneyllopharyngitis, scarlet fever, sepsis, glomerulonephritis, rheumatism, erysipelas. Other groups of streptococci (greening, non-hemolytic) play a less significant etiological role in the furuncle of the nose and other pustular skin diseases.

Pathogenesis

The emergence and development of the boil of the nose is largely determined, on the one hand, by pathogenicity and virulence of pathogens, and on the other, by a combination of various exogenous and endogenous factors that form a predisposition to the development of a purulent process. The entrance gate for infection is usually a violation of the integrity of the skin of the vestibule of the nasal cavity and external nose, which occurs during microtraumas (maceration, scratching); skin contamination (neglect of basic hygienic rules for everyday skin care of the face, the impact of production factors: coal, industrial cement dust, fuel and lubricants). In addition, the appearance of a boil of the nose can contribute to hypothermia, or overcooked, adversely affecting the anti-infective resistance of the skin.

A significant role in the pathogenesis of the furuncle of the nose is played by various endogenous factors, accompanied by a decrease in the bactericidal properties of sweat and secretion of sebaceous glands, a violation of the functional activity of the immune system. These violations lead to the persistence of the pathogen on the skin surface, the formation of a staphylococcal carrier state, the occurrence and recurrence of nasal boils, as well as other localizations. In this connection, genetically determined conditions accompanied by immune deficiency, endocrine diseases, especially diabetes mellitus, have an extremely adverse effect on the incidence, course and prognosis of the boil of the nose. Hypovitaminosis, poor nutrition, diseases of the digestive system, etc.

[9], [10], [11]

Symptoms of the nose boil

The boil is most often located on the tip and wings of the nose, on the eve of the nasal cavity, on the skin of the nasal septum. In most cases, there is a gradual development of the inflammatory process, which is first located in the mouth of the hair follicle (ostiofollikulit), then spreading deep into. Within 1-2 days a seal, hyperemia, edema of the skin is formed here, pain appears, aggravated by tension of the facial muscles, chewing, examination of the nose (with anterior rhinoscopy). These changes are accompanied by headache, weakness, fever. From the side of peripheral blood, as a rule, there is a shift of the leukocyte formula to the left, an increase in the ESR.

Later, with a favorable course of the process, within 2-4 days, the density of tissues in the focus of inflammation decreases, softening occurs in the center of the infiltrate, a small amount of pus is released, the necrotic rod is rejected, and the remaining cavity of the abscess is quickly cleaned and filled with granulations. As a rule, there is a decrease in the intensity of pain, normalization of body temperature, improvement of the general condition.

In some cases, abscess formation of furuncle may occur - progression of inflammatory inflammatory changes, an increase in the area of tissue necrosis, thinning of the skin, the appearance of fluctuations.

[12]

Stages

Nasal furuncle is one of the manifestations of staphylococcal pyodermatitis, which include ostiofollikulit, sycosis, deep folliculitis, hydradenitis, multiple abscesses of children, pemphigus neonates. In the development of the boil of the nose, as well as any acute purulent-necrotic inflammation of the hair follicle and the surrounding tissues, there are usually two stages:

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

Complications and consequences

The characteristic symptoms of a complicated nose furuncle are facial phlebitis symptoms: pain, induration and sometimes redness along the affected vessel, swelling of the upper and lower eyelids, soft tissues of the infraorbital region, forehead, fever up to 38.5 C and above, stunning chills, weakness. When a septic thrombosis of the venous sinus occurs, a violent infection syndrome with high fever, chills, and sweating develops. In typical cases, there are dyscirculatory disorders (pastoznost, swelling of the periorbital region, injections of the conjunctival veins, chemosis, exophthalmos, congestive changes in the fundus).

[13], [14],

Diagnostics of the nose boil

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

When examining patients with a boil of the nose should be borne in mind a high probability of developing septicemia and (or) septicopyemia. This is largely 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 a so-called dangerous triangle area of the face, bounded by lines connecting the middle point of the frontal-nasal suture (nasion) with the corners of the mouth. The outflow of venous blood from these anatomical zones is carried out along the angular vein, the internal orbital vein into the cavernous sinus. This circumstance creates real prerequisites for the spread of infection, not only in the adjacent anatomical zones: eyelids, eye socket, but also the base of the skull, intracranial veins and sinuses.

In the peripheral blood, neutrophilic leukocytosis, an increase in ESR is determined.

Indications for consulting other specialists

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

[15], [16]

Treatment of the nose boil

The goal of treatment for a furuncle (carbuncle) of the nose is to regress local inflammatory changes, normalize the patient’s general condition, and restore the ability to work.

Indications for hospitalization

The presence of a boil of the nose is an indication for hospitalization of the patient.

[17], [18], [19], [20]

Non-drug treatment

With an increase in body temperature, bed rest, liquid poor, and limitation of movements of the facial muscles are prescribed. Physiotherapeutic methods of influence have anti-inflammatory and analgesic effects: Solux, UHF.

[21], [22],

Drug treatment

The nature of the treatment of a boil of the nose depends on the stage of the inflammatory process. At the initial stage of the development of the process (infiltration stage), careful rubbing of the skin around the inflammation center with 70% ethyl alcohol solution or 2% salicylic alcohol solution is shown. In the first hours after the onset of infiltration, repeated lubrication of pustules with 5% iodine tincture has a good effect.

Local antibiotic therapy consists of using drugs of fueidic acid (2% ointment), mupirocin (2% ointment).

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

Surgery

Surgical treatment is indicated for abscess formation of the boil. An autopsy of a formed abscess is performed under local infiltration anesthesia or under general (intravenous) anesthesia. An incision is made that passes through the center of the inflammatory infiltrate; the edges of the abscess cavity are expanded with a mosquito-type hemostat or other similar tool. With abscess formation of a boil and with pronounced reactive phenomena from the adjacent tissues, contraception is superimposed. In order to prevent iatrogenic aesthetic disorders when making incisions in the area of the external nose, it is necessary to focus on the natural folds of the skin, and when opening the abscess of the vestibule of the nose, avoid damaging the edges of the nostrils. After evacuation of pus and detritus, drainage is introduced into the cavity (a strip of glove rubber), an aseptic bandage is applied, or a nasal vestibule with a hypertonic solution (10% sodium chloride solution) or antiseptic solutions is loosely tamped.

Approximate periods of disability for an uncomplicated course of the disease are 7-10 days, in the presence of septic complications - up to 20 days or more.

[23], [24]

Further management

In case of recurrent furuncles of the nose, clinical and immunological examination, consultation of an endocrinologist is indicated. Recommendations for patients should contain information on the inadmissibility of massaging the area of inflammation, attempts to squeeze the contents of the boil, self-treatment.

[25], [26], [27]

Prevention

The primary prevention of furuncle (carbuncle) of the nose, as well as other purulent-inflammatory skin diseases, is to prevent 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 the rules of personal hygiene, the systematic use of detergents, face care creams.

Secondary prevention of a boil of the nose (carbuncle) of the nose is a set of measures aimed at preventing the recurrence of the boil of the nose and (or) its complications in individuals of the risk group. First of all, we are talking about patients with pustular skin diseases (pyoderma) of the nasal area and nasal vestibule (folliculitis, sycosis), patients with diabetes, immunodeficiency states of various genesis. Examination, systematic medical examinations, the level of awareness of patients about the causes and clinical manifestations of the boil of the nose, possible complications of this disease, the need to consult an otorhinolaryngologist to decide the question of further treatment play an extremely important role. 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.

[28], [29]

Forecast

The prognosis for uncomplicated course and adequate treatment is favorable. If there are complications, associated diseases, the prognosis is determined by the prevalence of the process and the severity of the condition, timeliness and adequacy of therapeutic measures, the degree of compensation for associated diseases.