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Nasal Folliculitis: Causes and Treatment

As a former USN Hospital Corpsman, John draws from many years of experience in surgery and general sick bay treatment.

Infected hair follicle in nostril

Infected hair follicle in nostril

Folliculitis in Nose

Any discussion of nasal folliculitis requires an understanding of what folliculitis is. Once the basics are covered, this article will examine the common causes of folliculitis and its treatment. The information contained within is for entertainment and information only and is not given as a substitute for a physician's advice.

What Is It?

Folliculitis is an infection or inflammation of a follicle. A hair follicle is comprised of a sack where the hair begins to grow, an attached gland producing sebum or oil for the hair, and a canal leading to the surface of the skin.

Therefore, a hair follicle is an opening to the surface of the skin from which a hair grows. This opening can sometimes get infected. The most common bacterial infections come from staphylococcus aureus. There can also be fungal and viral infections. Other causes are hot-tub folliculitis (pseudomonas aeruginosa), barber's itch caused by staph (face, beard, and lip), viral herpes simplex of the mouth, and a fungal infection similar to barber's itch caused by T. rubrum.

When any of these infectious agents are harbored in the hair opening, folliculitis can begin. As stated, the usual culprit is staphylococcus aureus.

A single lesion folliculitis, non-nasal

A single lesion folliculitis, non-nasal

Does It Spread?

Some folks (30 percent) are staphylococcus aureus carriers. That means they can harbor quite a bit of it and not get sick. Some folks can carry it just in their noses. However, all these folks can infect others. This is good to be aware of and one more reason to emphasize the importance of good hand washing.

Pimples in the Nose

When a hair follicle in the nose gets irritated, it is referred to as nasal folliculitis. There are two main reasons for nose follicles to get infected. The nasal cavity is lined with normal tissue called mucosa. When the tender tissue inside the nose is nicked, it can result in infection. The cut which affects the nostril follicles becomes infected with staph aureus. This can frequently happen when the nose is picked. It is best to just blow the nose. If mucous hardens, use a warm soapy cloth to loosen and wipe it away. At this point, topical antibiotics purchased over-the-counter can give good results. Some are bacitracin, polysporin, and Neosporin. I have found that bacitracin is most often recommended, but I tend to be a bit allergic and have found Neosporin effective. According to the literature, Neosporin is well tolerated by mucosal surfaces. Prescription topical antibiotics include Clyndamycin and mupirocin. Prescription oral antibiotics include penicillin, or because resistance to that antibiotic continues, dicloxacillin or a cephalosporin are then the first therapeutic choices.

Another reason for this type of folliculitis is that the nasal hair opening fills with staph, which causes infection. This results in a sore area inside the nose and a scab that adheres tightly. The scab is made up of puss and serous exudate. Indeed, if a tissue is gently held next to the sore, a clear fluid slightly tinged with red and a light yellow substance can be seen.

Many people think that the sore area is caused by an ingrown hair. Though this is possible, many times, it is just an open follicle that has become infected. Grabbing hairs near the area and pulling them out with tweezers just causes more open follicles and an increased chance of folliculitis. It isn't a good idea. If you have an ingrown hair causing persistent problems, a physician can help by draining the site. Some ingrown hairs can be treated with an electric needle which destroys the follicle (permanently closing the follicle). But with the nostril, it is possible to cause a problem scar. Consult a physician if you have incessant ingrown hair problems. A trip to your HMO primary care physician will result in oral antibiotic treatment and/or a referral to an EENT specialist.

Gray's Anatomy diagram of a hair follicle from 1918. Gray's Anatomy, Plate 944

Gray's Anatomy diagram of a hair follicle from 1918. Gray's Anatomy, Plate 944

My Experience

In my own experience, I have noticed a common pattern to my nasal folliculitis. As I have grown older (age 68), I seem to be more susceptible to bronchitis. It may be due to my exposure to my grandchildren's colds while babysitting or a natural predisposition because of an older immune system. Whatever the reason, the head congestion along with the respiratory problems results in a lot of sinus discharge. The hair in my nose traps the mucous, and it hardens no matter how much I blow my nose. It would be tempting to pick at that, but that would result in yanking out more hairs, contributing to more folliculitis self-induced. And, it is an unsanitary practice, especially when you consider that staph can be caught under the fingernails and transferred.

Nasal Wash

My best solution is breathing steamy air in the shower and washing the inside of my nose. I use the corner of a wash cloth and antibacterial soap and twirl it repeatedly in the nostrils. Washing this way all the time has reduced the incidence of infection. Some professional recommendations have been to do it 2-3 times a week, but I have found a daily routine helpful. The soap I use is mild enough that it doesn't dry out and crack the mucosa, but be aware of that issue too.

Then I cup my hand with fresh water and shake my nose in it for a rinse. I do this regardless of the presence of nasal folliculitis. If folliculitis is present, I apply Neosporin with a q-tip to the area that is now without a scab. Usually, that does the trick. If I don't seem to be making headway, after cleaning, I will apply a drop of hydrogen peroxide 3%. Not only is it a good antiseptic, but if experiencing quite a bit of pain, it can give immediate relief. Don't snort the hydrogen peroxide! It can cause kidney damage if consumed orally. I apply it and wait a few minutes, then pat the area dry with a tissue. When I consulted a doctor about this drop in the nose, she said, "That's not enough to cause a problem."

One More Issue

If a nasal folliculitis is deep and extensive, one can see the outside of the nose above the infection turn red. If not treated, this can result in a boil on the nose. People sometimes think it is on the surface and "just a pimple," but the root of the problem is inside the nose. This is the next phase of severity. If possible, treat this problem at the beginning of the red phase before it turns into a carbuncle. Infections of the head and face if untreated can travel to the brain.

Naturopathic Aids

The use of vinegar or salt water to treat nasal pimples can also be of help.

A mixture of three drops of oil of oregano in one tablespoon of hydrogen peroxide and two tablespoons of water has helped some of Dr. Ben Kim's patients. Since oregano can sting, he suggests having a bowl of cold salt water ready for rinsing.

Sources, Picture of the Hair, Matthew Hoffman, MD, WebMD, WebMD Image Collection Reviewed by Carol DerSarkissian on March 11, 2017, Einstein Websites, Copyright 2016 - 2017 Einstein Industries, all rights reserved, NYU Longone Medical Center, Mark sjoberg, Treat the Root Cause, Not Just the Symptoms, copyright 2013-2017, Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved., Written, Edited or Reviewed By:Pramod Kerkar, MD, FFARCSILast Modified On: July 11, 2017 Pain Assist Inc., Title: Folliculitis Management and Treatment, Updated: Mar 23, 2017 Author: Elizabeth K Satter, MD, MPH; Chief Editor: Dirk M Elston, MD, Dr Ben Kim, Experience Your Best Health, Jun 02, 2014 in Natural Health Solutions, Dr. Ben Kim's blog, Michal Vilivosky, Charles University, Prague, Czech Republic, Bactroban versus Neosporin detailed comparison, October 30, 2015 8:10 PM

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2017 John R Wilsdon