Eczema of the nose is a dermatological disease accompanied by an inflammatory reaction of the skin of the vestibule of the nose. Typical symptoms: hyperemia, swelling, burning, itching, vesicular-pustular rash, which is replaced by wet manifestations and purulent crusts, lichenification, excoriation, peeling and pigment spots. Diagnosis is based on anamnesis data, patient complaints, results of external examination, dermatoscopy, allergy tests and other laboratory methods of research. Treatment consists of local and systemic drug therapy, physiotherapy procedures.
ICD 10
L20.9 Atopic dermatitis, unspecified
General information
Eczema of the nose is a relatively common dermatological pathology of ENT organs. According to statistics, its prevalence is in the range of 3.3-11.5 cases per 1,000 population. It accounts for more than 1/3 of all dermatological diseases of this anatomical area. Eczema of the nose occurs in patients of all age categories, in the vast majority of cases children and adolescents suffer. In recent years, there has been a trend towards an increase in the incidence rate among people aged 20-35 years. This is due to the growing number of patients with chronic lesions of the nose and paranasal sinuses, systemic and allergic pathologies.
Causes
Eczema of the nose is the result of a malfunction of several body systems at once. It usually develops against the background of hypersensitivity to certain antigens, the presence of genetic mutations and functional changes in the central nervous system. To a lesser extent, its formation is facilitated by dysfunction of the endocrine glands, immunodeficiency conditions, and chronic stress. The most common triggers include:
- Foci of chronic infection. They include diseases of the nasal cavity and paranasal sinuses of the nose, accompanied by the release of mucous or purulent masses. Most often these are rhinitis, adenoiditis, eustachiitis, sinusitis, frontitis of various etiologies. Less often, other pathologies of the upper respiratory tract contribute to the occurrence of eczema: nasopharyngitis, tonsillitis, stomatitis.
- Physical and chemical stimuli. The provoking factors are cosmetics, industrial volatile chemicals and gases, regular hypothermia. Traumatic injuries, mechanical friction, radiation therapy of the facial area play a certain role. The latter also reduces the body’s local defenses.
- Insufficient immunity. Eczema can form with endocrinopathies (decompensated diabetes mellitus, hypothyroidism, lesions of the testicles or ovaries, pituitary gland), chronic pathologies of the gastrointestinal tract, vitamin deficiency, infectious diseases, including HIV infection, prolonged use of cytostatics, malignant tumors.
Pathogenesis
The pathogenesis is based on polyethological neuro-allergic dysfunction. It is manifested by polyvalent (rarely monovalent) sensitization of the skin, which causes an inadequate response to external and internal stimuli. This is accompanied by an increase in the tone of the parasympathetic autonomic nervous system, which, in turn, leads to active exudation due to damage to the muscle layer of the walls of the vessels of the microcirculatory bed.
The existing lack of immunity is usually caused by impaired functions of macrophages, helper T-lymphocytes, neutrophil leukocytes, excessive synthesis of class G and E immunoglobulins against the background of class M deficiency. Secondary infection of the affected tissues provokes the development of a chronic inflammatory process due to the production of autoantibodies.
Classification
Taking into account the etiology and features of the clinical course, it is customary to distinguish various forms of eczema of the nose. The division is due to the need to use different therapeutic and prophylactic agents for different variants of the disease, simplifying differential diagnosis. The following pathology variants are characteristic of this localization:
- Idiopathic. It is characterized by a constantly recurring course. The reason for the development of exacerbations often remains unknown, a minimal trigger is sufficient to activate the process.
- Microbial. It develops as a result of infection of damaged skin, including cuts, scratches or trophic ulceration, increased sensitivity of the body to infectious antigens. Contributing factors are acute or chronic lesions of the nasal cavity and paranasal sinuses.
- Seborrheic. It is observed in persons suffering from excessive sebum secretion – seborrhea. In addition to the vestibule of the nose, signs of eczema develop in characteristic “seborrheic” foci. Often this variant of the disease is regarded as a marker of AIDS.
- Fungal. Accompanies hypersensitivity of the body to fungal antigens. This form of eczema lesion can be provoked by candidiasis of the nasal cavity, ringworm, other mycotic lesions of the mucous membranes of the nasal cavity or the skin of this area.
- Childish. It is formed in children with constitutional abnormalities of the type of exudative diathesis or hereditary predisposition to allergic diseases. The risk of developing eczema in infants increases with complications of pregnancy, the presence of concomitant pathologies in the mother.
- Contact. Occurs in persons who are in regular or constant contact with allergens. Usually these are workers of various industries that use artificial paint and varnish materials, resins, formaldehyde, nickel or chromium salts.
- Sycosiform. It is observed in patients suffering from sycosis – a chronic pustular lesion of hair follicles in the nasolabial fold. Men are more prone to this form of eczema.
Symptoms
All forms of the disease are characterized by the stage of development of clinical manifestations – evolutionary polymorphism. At the first stage (erythematous), there is acute redness of the skin of the vestibule of the nose, swelling, itching and burning sensation. In some cases, subjective feelings are so strong that they lead to sleep disorders and other neurotic disorders. When touching the affected areas, acute pain appears, and there is often no pain syndrome at rest. With microbial and fungal forms of eczema, pronounced boundaries between affected and healthy tissues are visible, the process is often asymmetric.
On 2-3 days from the onset of the disease, against the background of primary signs of inflammation, pustules and vesicles filled with turbid fluid appear – eczema passes into the papulo-vesicular stage. Elements with different etiopathogenetic variants of pathology have different characteristics. Their size varies from 1-2 mm to 1 cm in diameter, color – from light yellow to brown. A characteristic feature of seborrheic eczema is the merging of pustules and vesicles with the formation of so–called “garlands” or “rings”.
After a few more days, the stage of wetness begins – the elements of the skin rash are opened, leaving behind “serous wells” – specific erosions, from which a moderate amount of exudate is released. The latter leads to maceration, increases inflammatory reactions. The greatest number of manifestations occurs in the corners of the nostrils.
The next stage is cortical. It is accompanied by drying of “wells”, the formation of purulent crusts or scales over the affected skin, excoriation, lichenification. In the microbial form, gray-yellow crusts almost completely cover the tissues, and at the periphery there is a pronounced rejection of the stratum corneum of the epidermis. In other forms, there are areas of “enlightenment”.
The total duration of acute eczematous lesions of the vestibule of the nose does not exceed 15-20 days. After that, the crusts are rejected, the disease becomes chronic. Clinically, chronization is manifested by infiltration and induration of the skin of the vestibular part of the nose, limited foci of increased dryness, cracks. Peeling, itching, burning persist, but become less noticeable. With idiopathic eczema, secondary depigmented or pigmented vascular spots are formed, gradually increasing in size.
Complications
Complications are associated with the addition of new strains of pathogenic microflora – superinfection – to the already infected skin tissues of the nasal vestibule. The most common complications are impetigo, furunculosis, erysipelas of the external nose, cheeks and other areas of the face. In children with exudative-catarrhal diathesis, the disease can transform into atopic dermatitis (neurodermatitis), and infection with herpes viruses can lead to a severe form of Kaposi’s herpetiform eczema.
With severe immunodeficiency, erythroderma, thrombophlebitis of the facial veins may be observed. This process can provoke the development of intracranial complications – cavernous sinus thrombosis, meningitis, meningoencephalitis, etc.
Diagnostics
For an experienced otolaryngologist or dermatovenerologist, diagnosis is not difficult. Anamnestic data, patient complaints and physical examination are used. During the collection of anamnesis, the doctor pays attention to the presence of etiological or contributing factors: working conditions, concomitant pathologies, previous treatment, prescribed medications. During the examination of the child, the course of pregnancy, available at the time of carrying the disease in the mother, is found out. Next, the following diagnostic methods are used:
- External examination and anterior rhinoscopy. Visual examination of the nasolabial region and nasal cavity allows you to identify changes in the vestibular part characteristic of one of the stages of the disease. With different forms of eczema, various variations of limited or diffuse hyperemia and edema, vesicular-pustular rashes, “serous wells” or purulent crusts are determined.
- Dermatoscopy. It is used for a detailed study of changes in the skin, differentiation with other pathologies. With a tenfold increase in the dermatoscope, an uneven point distribution of regional blood arterioles, venules and capillaries is revealed in combination with peeling of the stratum corneum of the skin, the formation of crusts.
- Blood test. A clinical blood test at the initial stages of the disease shows an increase in the level of eosinophils and an increase in ESR. When bacterial flora is attached, neutrophilic leukocytosis occurs. When assessing the level of immunoglobulins, high levels of total IgE, IgG are observed.
- Allergic test. They are carried out to determine substances that, upon contact with the skin of the vestibule of the nose, trigger an allergic reaction. This test is widely used in the true and professional form of the disease, since with them the provoking factor often remains unknown.
- Microbiological examination. Makes it possible to identify pathogenic flora. As a material for the study, secretions from “serous wells”, smears of the affected skin are used. After obtaining colonies of microorganisms in the laboratory, their sensitivity to antibiotics is determined.
- Skin biopsy. Cytological and histological examination of skin samples is resorted to when it is impossible to carry out differential diagnosis by other methods. Often, a biopsy is performed at the onset of eczema or with its atypical course.
Treatment
Treatment of eczema of the nose is conservative, includes local and systemic medications, physiotherapy procedures. The therapeutic scheme is made individually taking into account the age of the patient, concomitant diseases, the form of eczema, the stage of its development. The elimination or minimization of contact with allergens plays an important role. Further treatment includes three categories:
- Systemic pharmacotherapy. At the initial stage, hyposensitizing drugs, H1-histamine blockers, “small” tranquilizers, neuroleptics, multivitamins, NSAIDs, immunostimulants are used. For the prevention or treatment of bacterial infection, antibiotics are used, selected taking into account antibiotic sensitivity. In severe cases, corticosteroids are prescribed in combination with anabolic hormones.
- Local treatment. At the wet stage, cooling lotions based on boric acid or resorcinol are shown, after which topical glucocorticosteroids and keratoplastics are used. In case of bacterial or fungal infection, local antibacterial or antifungal agents, aniline dyes are used. Stimulation of the rejection of crusts and the fight against peeling is carried out with the help of intranasal tampons with sea buckthorn or vegetable oil.
- Physical therapy. It is prescribed after the relief of an acute process or in the treatment of chronic eczema. UHF therapy, helium-neon laser, acupuncture are widely used. To combat induration and lichenification, applications with paraffin, ozokerite, therapeutic mud are used. In rare cases, they resort to X-ray therapy. Sanatorium-resort treatment in coastal regions is considered effective.
Prognosis and prevention
The prognosis for life with eczema of the nose is favorable, for health – doubtful, depends on the ability to terminate the patient’s contract with provoking factors, correct existing systemic disorders. Depending on the clinical form of the disease and the effectiveness of the selected treatment regimen, recovery or complete clinical remission occurs by the end of 3 weeks. Preventive measures include the prevention of contact with allergens, minimizing or completely abandoning the use of cosmetics, adequate timely treatment of concomitant nosologies, strengthening the body’s overall defenses.
