Scab inside of left nose not healing

Posted by ofbushido @ofbushido, Mar 27 8:13pm

Hello All,

I have a scab inside my left nose for the last couple of months that won't heal. It's on the mucous membrane. I reached out to my doctor who later referred me to an ENT, but their treatment is not working, so I'm looking for someone who experienced this before and could perhaps help me out. They think it's just dry nose.

At first I noticed the scab when I was blowing my nose and saw dried blood and felt stinging. When I looked inside my nose with an otoscope, I saw the attached pictures, which I sent to my doctor. He said it's an infection and put me on a 10 day Mupirocin ointment with instruction to keep it moist for a week after that antibiotics course is done. So I applied saline gel every two hours for a week straight, but as you can see from the pictures the scab is back at full force, so I don't think it's related to dryness, but I'm not a doctor.

Here is a description of the pics:
Pic 1: before the Mupirocin treatment started
Pic 2: halfway through the treatment
Pic 3: after the Mupirocin treatment ended
Pic 4: now

Any help would be appreciated.

Thank you.

@ofbushido Hi and welcome to Mayo Clinic Connect. We’re not medical professionals so we can’t diagnose conditions. But we can rely on our experiences to help out.
I can understand your concern. You’ve taken some impressive pictures of your nasal passage and the area that’s scabbed over. I just want to clarify that you were not actually seen by your doctor? You sent the photos and a diagnosis was made from the photos but not by physical exam?

If this were me, I’d be seeking a second opinion from a dermatologist. That area requires at least an actual physical exam of the lesion and possibly a biopsy just to make sure nothing else is going on. Considering it’s been winter, air is dry in the house, sometimes our mucosa does dry out and you can get a scab-like build up of dried mucous. But generally, it flakes off and heals over. You’ve done the right thing with applying the saline gel on a regular basis.

I think your next step would be to contact your physician to get a referral to a dermatologist. if for nothing else to ease your mind. In the meantime, you could try an over the counter nasal spray called X-lear. It contains Xylitol, promotes healing and does a good job of keeping the area moist and healthy. Good luck and let me know how your appointment goes! Lori

REPLY
@loribmt

@ofbushido Hi and welcome to Mayo Clinic Connect. We’re not medical professionals so we can’t diagnose conditions. But we can rely on our experiences to help out.
I can understand your concern. You’ve taken some impressive pictures of your nasal passage and the area that’s scabbed over. I just want to clarify that you were not actually seen by your doctor? You sent the photos and a diagnosis was made from the photos but not by physical exam?

If this were me, I’d be seeking a second opinion from a dermatologist. That area requires at least an actual physical exam of the lesion and possibly a biopsy just to make sure nothing else is going on. Considering it’s been winter, air is dry in the house, sometimes our mucosa does dry out and you can get a scab-like build up of dried mucous. But generally, it flakes off and heals over. You’ve done the right thing with applying the saline gel on a regular basis.

I think your next step would be to contact your physician to get a referral to a dermatologist. if for nothing else to ease your mind. In the meantime, you could try an over the counter nasal spray called X-lear. It contains Xylitol, promotes healing and does a good job of keeping the area moist and healthy. Good luck and let me know how your appointment goes! Lori

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Hi @loribmt , thank you for the quick response. Yes, you are correct, I emailed the pictures to my doctor who forwarded it to his ENT. I never got a physical exam. Your suggestion makes a lot of sense. I will make an appointment. So I should be making the appointment with a dermatologist and not an ENT? Thank you 🙂

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@ofbushido

Hi @loribmt , thank you for the quick response. Yes, you are correct, I emailed the pictures to my doctor who forwarded it to his ENT. I never got a physical exam. Your suggestion makes a lot of sense. I will make an appointment. So I should be making the appointment with a dermatologist and not an ENT? Thank you 🙂

Jump to this post

@ofbushido Either doctor should be able to make a good diagnosis. The ENT, since it’s their speciality area would certainly know if this looks normal or not. But I think a physical exam is in order.
When the ENT gave you the recommendation to use the saline gel, did they feel this was an infection or just a dry area? Was this after your GP gave you the antibiotics for what he thought was an infection?
You could reach out to the ENT clinic again and get in to see a doctor there. You may not need a referral since you’ve already been in contact with them.

A dermatologist would also be a good option as this is a lesion on the skin and that’s their purview. You could ask your doctor which is the best option for the situation. But then you make the decision and be direct if you feel you’re not being taken seriously. You are concerned and this needs to be addressed. It’s been going on long enough. 😊

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@loribmt

@ofbushido Either doctor should be able to make a good diagnosis. The ENT, since it’s their speciality area would certainly know if this looks normal or not. But I think a physical exam is in order.
When the ENT gave you the recommendation to use the saline gel, did they feel this was an infection or just a dry area? Was this after your GP gave you the antibiotics for what he thought was an infection?
You could reach out to the ENT clinic again and get in to see a doctor there. You may not need a referral since you’ve already been in contact with them.

A dermatologist would also be a good option as this is a lesion on the skin and that’s their purview. You could ask your doctor which is the best option for the situation. But then you make the decision and be direct if you feel you’re not being taken seriously. You are concerned and this needs to be addressed. It’s been going on long enough. 😊

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@loribmt Thank you for the recommendation. I'll contact them on Monday.

To answer your question, at first, my regular doctor thought it was an infection upon examining my picture. He prescribed Mupirocin for twice a day for five days. He asked me to send him pics after five days. When I did, he forwarded those pics to the ENT, since the scab didn't cure all the way. The ENT ordered another five days of Mupirocin, but this time four times per day. He also said that after this treatment to aggressively use saline gel so that scab doesn't dry up.

I asked the ENT what the white patch was and he said it looks like scar tissue. I also asked him what he thought it was from and he said more than likely from dry air.

One thing that I forgot to mention that I'm not sure is important is that if you look into my right nose (the one that's fine) with the otoscope, you can barely get into it, because the mucous membrane is close to the septum. But the left nostril has significantly more space as you can see from the picture. I'm not sure if that space difference in each nostril is normal or caused by this issue.

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@ofbushido

@loribmt Thank you for the recommendation. I'll contact them on Monday.

To answer your question, at first, my regular doctor thought it was an infection upon examining my picture. He prescribed Mupirocin for twice a day for five days. He asked me to send him pics after five days. When I did, he forwarded those pics to the ENT, since the scab didn't cure all the way. The ENT ordered another five days of Mupirocin, but this time four times per day. He also said that after this treatment to aggressively use saline gel so that scab doesn't dry up.

I asked the ENT what the white patch was and he said it looks like scar tissue. I also asked him what he thought it was from and he said more than likely from dry air.

One thing that I forgot to mention that I'm not sure is important is that if you look into my right nose (the one that's fine) with the otoscope, you can barely get into it, because the mucous membrane is close to the septum. But the left nostril has significantly more space as you can see from the picture. I'm not sure if that space difference in each nostril is normal or caused by this issue.

Jump to this post

@ofbushido The extra information you provided regarding your doctor and the ENT eases my mind a little. That at least they did pay attention to the photos. But since it’s been going on so long, regardless, it might be a good idea to have your doctor or ENT take an actual look at the area.
I’m not sure about the inside of your nose regarding the spacing or why it’s different. Looking up my own nose, it’s totally not symmetric. LOL. Looks like I came up on the wrong end of a fist but I’ve never been hit on my nose.

But, now I’m curious. Are you getting as much air going through your right side as you are the left? Maybe your left nostril is dryer because more air passes through??? Even still, “months” seems like a long time for that particular area to be dry. Though I know when going through my chemo treatments, staying in the hospital the air was so dry, I needed petroleum jelly in my nose.

Anyway, this is troubling you enough that I think you’d feel better with a visual, in person visit to your doctor or ENT. ☺️

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@loribmt LOL, I love your description of your nose symmetry. It gave me a good laugh.

I seem to be breathing about the same through both nostrils. I tested them separately lol. I just learned that the part of my nose that's bigger than the other is called the inferior turbinate which apparently can inflame with seasonal allergies. I'm learning as I go, but you are right, the best way is an in-person visit which I will definitely do. I'm glad to be more informed about the topic. Thank you so much for your help and leading me to the right direction 🙂

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@ofbushido

@loribmt LOL, I love your description of your nose symmetry. It gave me a good laugh.

I seem to be breathing about the same through both nostrils. I tested them separately lol. I just learned that the part of my nose that's bigger than the other is called the inferior turbinate which apparently can inflame with seasonal allergies. I'm learning as I go, but you are right, the best way is an in-person visit which I will definitely do. I'm glad to be more informed about the topic. Thank you so much for your help and leading me to the right direction 🙂

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@ofbushido Glad to have helped. Where the nose leads, we follow. 😉
Keep me posted! Lori

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@ofbushido Hello! Thought I’d check in to see how you’re doing with the nose issue. Were you able to get an appointment for someone to take a look at the area? Any signs of it healing?

I also had another thought on the subject. Sometimes when I wake up in the morning, if the bedroom is particularly dry with the furnace running a lot, I have gotten similar scabby looking things in the tissue after I blow my nose in the morning. I bought a little portable vaporizer, usually sold at drug stores or baby sections of dept stores. That really helped keep my sinuses from drying out at night. Also nasal rinses like Xclear work really well.
Anyway, I hope you’re getting some relief and this heals quickly for you! Lori.

REPLY
@ofbushido

@loribmt Thank you for the recommendation. I'll contact them on Monday.

To answer your question, at first, my regular doctor thought it was an infection upon examining my picture. He prescribed Mupirocin for twice a day for five days. He asked me to send him pics after five days. When I did, he forwarded those pics to the ENT, since the scab didn't cure all the way. The ENT ordered another five days of Mupirocin, but this time four times per day. He also said that after this treatment to aggressively use saline gel so that scab doesn't dry up.

I asked the ENT what the white patch was and he said it looks like scar tissue. I also asked him what he thought it was from and he said more than likely from dry air.

One thing that I forgot to mention that I'm not sure is important is that if you look into my right nose (the one that's fine) with the otoscope, you can barely get into it, because the mucous membrane is close to the septum. But the left nostril has significantly more space as you can see from the picture. I'm not sure if that space difference in each nostril is normal or caused by this issue.

Jump to this post

@ofbushido. I had a similar thing and used triple antibiotic ointment at least 2x a day in the nostril. It seemed to take forever but after a month it was gone. This is just what worked for me, not sure if a dr would agree. I tried Vaseline first and that didn’t help. But you have to use it religiously.

REPLY
@loribmt

@ofbushido Hello! Thought I’d check in to see how you’re doing with the nose issue. Were you able to get an appointment for someone to take a look at the area? Any signs of it healing?

I also had another thought on the subject. Sometimes when I wake up in the morning, if the bedroom is particularly dry with the furnace running a lot, I have gotten similar scabby looking things in the tissue after I blow my nose in the morning. I bought a little portable vaporizer, usually sold at drug stores or baby sections of dept stores. That really helped keep my sinuses from drying out at night. Also nasal rinses like Xclear work really well.
Anyway, I hope you’re getting some relief and this heals quickly for you! Lori.

Jump to this post

@loribmt Hi Lori. I hope you are well. I saw the on Thursday. He said it's just a minor bacterial infection. He said to continue using the antibiotics for three weeks. Hopefully that will do the trick 🙂

Ya, you are right about the dry air. I think that's the culprit.

REPLY
@bustrbrwn22

@ofbushido. I had a similar thing and used triple antibiotic ointment at least 2x a day in the nostril. It seemed to take forever but after a month it was gone. This is just what worked for me, not sure if a dr would agree. I tried Vaseline first and that didn’t help. But you have to use it religiously.

Jump to this post

@bustrbrwn22 Hi bustrbrwn. Thanks for the info. The ENT did say it's a minor bacterial infection. He put me on mupirocin antibiotics for three weeks. Hopefully that will take care of it 🙂

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…reminds me of when I first came to Canada and central hot air heating. Had lived in UK 18 years and it seems in those bygone days it rained every day and no central heating… so no dry nose! After a few winters here I got a "scab"up inside right nostril and it was on whatever that piece of bone or cartalege? is between nostrils and believe it or not I had it for many YEARS. Never saw Dr.about it. I would take it off with my finger and put vaseline on and then next time it bothered me, a few days, or weeks, especially winter of course, same thing. Those were days before computers and Dr.Google and being able to take photos of inside of nose. Thinking back am surprised it didn't turn to a cancer or spread all over…. it did not bleed very much at all…. just kept reappearing. Then it just suddenly stopped and now cant remember if when I moved to another house – with central hot water heating not hot air.. but why was it only in one nostril? I also remember years ago buying a tube of nasal gel , no prescription and wish I could think of the name and used very sparingly… sorry I cant be of more help with your issue but mine did end up leaving after a very very long time, and I never used antibiotics. Odd thing is now after all these years, for last year I am having a lot of clear nasal mucous I blow out in long clear strings…. about 10 times a day… honestly there is a saying "the nose knows" but I don't think mine does! Good luck. J.
ps how did you get your photos so small, i wanted to put some up but saw some before and they were huge!

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