Infection Inside the Nostril: Nasal Vestibulitis, Folliculitis and Nasal Boils
How a sore, crusty or swollen nostril is recognised, what causes it, the conditions it is mistaken for, and the warning signs that mean it needs urgent care.
Part of the Nasal Infection Guides.
Key fact: A sore, red, crusty patch just inside the nostril is usually nasal vestibulitis, a bacterial infection of the skin at the entrance to the nose, most often caused by Staphylococcus aureus. It is diagnosed by looking, rarely needs tests, and usually clears with an antibacterial nasal cream. Spreading redness, swelling of the face or eye, or a fever need prompt medical attention.
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See nasal infection treatments →What nasal vestibulitis is
The nasal vestibule is the first centimetre or so inside each nostril: the part lined with ordinary skin and small hairs before the moist lining of the nose begins. Because it is skin, it can get the same infections as skin elsewhere, and because it is touched, picked, blown and rubbed so often, it is particularly prone to them.
| Term | What it means |
|---|---|
| Nasal vestibulitis | Infection and inflammation of the skin just inside the nostril, usually spread over a small area |
| Nasal folliculitis | Infection of one or more hair follicles, seen as small red bumps or pustules around the nostril hairs |
| Nasal boil (furuncle) | A deeper, painful, pus-filled lump that develops from an infected follicle |
| Staphylococcal nasal carriage | Harmless presence of Staphylococcus aureus in the nose with no infection; important when it causes repeated boils or before some operations |
About a third of people carry Staphylococcus aureus in their nose at any time without any problem. Infection happens when the skin is broken and those bacteria get in.
Symptoms
| Common | Less common |
|---|---|
| Soreness or tenderness just inside the nostril | A painful, swollen lump with a yellow head (a boil) |
| Redness at the nostril rim | Redness spreading onto the outside of the nose |
| Crusting or scabs that reform after being removed | Swelling of the tip of the nose |
| Small red bumps or pustules around the hairs | Fever or feeling unwell |
| Pain when touching the tip of the nose | Swelling of the upper lip, cheek or around the eye |
The symptoms in the second column suggest the infection is deeper or spreading, and need assessment rather than home treatment alone.
What causes it
Anything that damages the skin inside the nostril lets bacteria in. The common triggers are:
- picking the nose, or rubbing it repeatedly
- frequent nose blowing during a cold or hay fever
- plucking or trimming nasal hairs
- nose piercings
- dry, cracked skin, for example in winter or from oxygen tubing
- a runny nose from allergies, which keeps the skin moist and irritated
- repeated use of some nasal sprays that dry the lining
Repeated infections, or boils that keep returning, can mean you are a persistent carrier of Staphylococcus aureus. That is treated differently from a single infection, as explained in Naseptin vs Bactroban Nasal.
How it is diagnosed
Nasal vestibulitis is diagnosed by looking. A pharmacist or doctor will look just inside the nostril with a light, ask how long it has been there and whether it has happened before, and check for spreading redness or swelling. No test is needed for a typical first episode.
| When a test may be done | What it shows |
|---|---|
| Infections or boils keep coming back | A nasal swab can confirm Staphylococcus aureus carriage and which treatments it is sensitive to |
| It has not responded to treatment | A swab can show resistant bacteria such as MRSA, or a different cause |
| Recurrent boils in you or your household | Testing for a toxin-producing strain called PVL, which needs specific treatment |
| Before some operations | Hospitals screen for MRSA carriage and may treat it beforehand |
Conditions it is mistaken for
Several other problems cause soreness or crusting around the nostril. Getting this right matters, because they are treated differently.
| Condition | How it differs | Treatment |
|---|---|---|
| Impetigo | Honey-coloured crusts that spread onto the skin around the nose and mouth; very contagious, common in children | Hydrogen peroxide cream or a topical antibiotic. See is it impetigo? |
| Cold sore | Tingling or burning first, then a cluster of small fluid-filled blisters, often on the rim or outside of the nostril or lip | Antiviral cream or tablets; antibacterial creams do not help |
| Dry, cracked skin or dermatitis | Dry, flaky and sore without pus or a lump; often from colds, blowing or the weather | A simple barrier ointment |
| Sinusitis | Pain and pressure in the face, a blocked nose and thick discharge from deeper in the nose, not a sore nostril | See sinusitis |
| Something stuck in a child’s nose | A smelly discharge, often from one nostril only, in a young child | Needs to be removed by a clinician |
Do not squeeze a boil or pustule inside the nose. The veins around the nose and upper lip drain towards the brain, so squeezing can push infection deeper. Very rarely this leads to a serious clot in a vein behind the eye. Leave it alone and let treatment work.
When to get urgent help
Seek same-day medical help, or call 999 if severe, if you have redness or swelling spreading across the nose or face, swelling of the upper lip, cheek or around the eye, a fever or feel unwell, a severe headache, double vision, pain or difficulty moving the eye, or drowsiness or confusion. These can mean the infection has spread into the surrounding skin or deeper.
See a GP or pharmacist if a sore nostril has not improved after a week of treatment, keeps coming back, or you have diabetes or a weakened immune system. Spreading infection of the surrounding skin needs antibiotic tablets rather than a cream alone.
Sore, Crusty Nostril That Will Not Settle?
Our pharmacist independent prescribers can assess your symptoms online, recommend Naseptin or Bactroban Nasal where suitable, and tell you if you need to be seen in person.
See nasal infection treatments →Frequently Asked Questions
What does nasal vestibulitis look like?
It usually looks like redness, soreness and crusting just inside the entrance of the nostril, sometimes with small red bumps or pustules around the hairs. The tip of the nose may be tender. A painful, swollen lump with a yellow head is a nasal boil, which is a deeper form of the same infection.
Is a sore inside the nose a nasal infection or a cold sore?
A cold sore usually starts with tingling or burning, then forms a cluster of small fluid-filled blisters, often on the rim of the nostril or near the lip. Nasal vestibulitis is more often a red, crusty, tender patch inside the nostril, sometimes with pustules around the hairs. Cold sores need antiviral treatment; bacterial infections need an antibacterial cream.
Can I squeeze a spot inside my nose?
No. The veins around the nose and upper lip drain towards the brain, so squeezing a spot or boil inside the nose can push infection deeper. Leave it alone, use the treatment you have been recommended, and seek medical help if redness spreads or the face or eye swells.
Why do I keep getting infections inside my nose?
Repeated infections are usually caused by repeated damage to the skin, from picking, frequent blowing or plucking nasal hairs, or by being a persistent carrier of Staphylococcus aureus bacteria in the nose. Repeated boils are a reason to ask about a nasal swab and a decolonisation course to clear the bacteria.
How long does nasal vestibulitis take to clear?
With an antibacterial nasal cream, most cases improve within a few days and clear within one to two weeks. If it has not improved after a week, is getting worse, or keeps coming back, see a pharmacist or GP.
When is a nose infection an emergency?
Seek urgent help if redness or swelling spreads across the face, the upper lip, cheek or area around the eye swells, or you develop a fever, severe headache, double vision, eye pain or drowsiness. These can mean the infection has spread and needs assessment and antibiotic tablets.
References
- National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Boils, carbuncles, and staphylococcal carriage; Impetigo. cks.nice.org.uk
- UK Health Security Agency. Panton-Valentine leukocidin (PVL): guidance, data and analysis. gov.uk
- NHS. Boils and carbuncles. nhs.uk
- NHS. Cold sores. nhs.uk
- Joint Formulary Committee. British National Formulary: nasal infection. bnf.nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Spreading redness or swelling of the face, a fever, or any eye symptoms with a nose infection need prompt medical assessment. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.