The inside of the nose (nasal cavity) is delicate and sensitive. Any slight irritation can cause significant discomfort. When we feel a bump inside our nose or soreness at just one spot, we often refer to it as a sore in the nose. However, a sore is not an accurate description of the problem. These sores could be a polyp, scab, cyst, ulcer,abscess or sometimes even tumors.
How do sores form in the nose?
The inner lining of the nasal cavity (mucosa) is similar to the lining throughout the airways although the thick nasal hairs are not seen beyond the nose. This mucosa is very sensitive and can be easily injured. Infections, abnormal growths and a build up of pus and other fluids can also occur in or on this lining. Depending on the type of lesion, the sore may form in a different way.
Inflammation is one of the more common causes of sores. It is the body’s mechanism to prevent tissue damage. Swelling is one of the features of inflammation along with pain, redness and heat. This swelling may be a sore when it is focal (occurring in one specific area). Other types of sores which often follow inflammation include:
- Abscesses (boils) which are a collection of pus often associated with an infection.
- Scabs which are the protective blood clot that prevents further bleeding.
- Ulcers are open sores that arise when the surface tissue erodes.
- Polyps are abnormal benign growths that protrude from the surface.
- Tumors are abnormal growths which can be malignant (cancerous) or benign (non-cancerous).
Causes of Sores in Nose
The nasal mucosa can dry quickly as air moves across it, into and out of the lower airways. This movement has a drying effect although nasal mucus moisturizes the lining. However, in dry climates the nasal mucosa becomes dried and nasal crusts form. A dry nasal lining can be sore and very hard nasal crust (boogers) can also injure the mucosa. Dryness may also worsen underlying nasal conditions.
Environmental dust is usually trapped by nasal mucus and swallowed or picked out of the nose as crusts. Sometimes the dust may be so excessive that it can coat the nasal lining. Depending on the type of dust, it can also injure the nasal mucosa or trigger an inflammatory response. This is more often seen with certain organic and inorganic dusts in an industrial setting, especially when appropriate protective wear like face masks are not used.
Picking the nose can also lead to sores, especially if it is frequent and rough. The fingers are teeming with bacteria, especially under the fingernails. These bacteria may then be introduced into the nose which can cause an infection or folliculitis. Furthermore aggressive nose picking can injure the nasal mucosa and lead to inflammation. This is worsened by long, rough and/or unclean fingernails.
An allergic reaction is where the body’s immune system responds to a fairly harmless substance. It leads to inflammation of the nasal mucosa. Allergic rhinitis is a common nasal condition where there is nasal congestion, sneezing and a runny nose or post nasal drip. This recurrent or persistent inflammation can also increase the likelihood of nasal infections. Repeated wiping of the nose can also cause further inflammation.
Viral and bacterial infection of the nasal cavity are not uncommon. The common cold is a frequently seen viral infection that can cause significant inflammation of the nasal lining and upper airways. As with allergies, there is nasal congestion, runny nose and sneezing. Sometimes pus may also be present. The infection can cause a range of different lesions from cysts, abscesses to other types of sores in the nose.
Folliculitis is a condition where the hair follicle becomes inflamed, usually due to an infection. Staphylococcus aureus is one of the common bacteria to cause folliculitis. It can infect the follicle of the nose hairs. The sore may be tender and painful and depending on the severity of the infection it can eventually rupture to ooze pus. There may also be other lesions on the skin itself.
Cold sores are caused by the herpes simplex virus (HSV). Although we usually associated it with the mouth, cold sores can also occur in the nose. These infections are usually chronic but may flare up with viral infections like the common cold or flu, with fever and other factors such as stress. Therefore a cold sore in the nose may arise at the same time as a cold sore around the mouth.
Some medication that can cause nasal inflammation, increase nasal mucus production or lead to drying of the nasal mucosa may also contribute to the formation of sores in the nose. Nasal sprays when used excessively to clear nasal congestion can worsen the condition with sores forming as a result of the inflammation (rhinitis medicamentosa). Also the insertion of the nasal spray may introduce bacteria into the cavity or can injure the nasal mucosa.
Autoimmune conditions are where the immune system attacks the body’s tissues although it is not a threat. These diseases can cause inflammation of the nasal mucosa and lead to soreness when the immune system targets the mucosal tissue. Sarcoidosis is an autoimmune condition where masses of tissue may form at sites of inflammation. These masses are known as granulomas.
Blood clots or scabs will form when there is a rupture of a blood vessel in the nose. This may lead to a nose bleed (epistaxis). It is not serious in most cases and usually due to trauma to the nose like a blow to the face. Sometimes it can also be caused by vigorous nose picking. Dry environments can also cause nose bleeds as can high blood pressure but only in a minority of cases.
There is no specific treatment for sores in the nose. The treatment will vary depending on the condition that causes the sore in the nose. Antibiotics may be used for infections, corticosteroids for chronic inflammation as is seen in allergies and autoimmune diseases, antihistamines for allergic conditions and decongestants for nasal congestion. A few simple measures can be useful for nasal health and possibly preventing sores in the nose:
- Use a saline nasal spray on a regular basis for a dry nose.
- Steam is also useful for moisturizing the nasal mucosa as is a humidifier within a room.
- Avoid picking the nose with the fingers, especially if you bite your finger nails.
- Blow out any mucus after moisturizing the mucosa but do not be forceful.