Psoriasis, a chronic autoimmune skin condition, typically manifests as red, scaly patches on various parts of the body. While it commonly affects areas like the elbows, knees, and scalp, it can also appear in less common locations, including inside the nose. Nasal psoriasis is a less frequent but possible occurrence. Understanding its characteristics and management is important for those who might experience it.
How Psoriasis Appears Inside the Nose
Nasal psoriasis can present with distinct physical signs and sensations. Individuals might observe redness, scaling, dryness, crusting, itching, or discomfort inside the nostrils. The condition can impact both the inner lining of the nose and the skin just inside the nostrils. On lighter skin tones, these patches may appear gray or white, while on medium skin tones, they can be pinkish with silvery scales. For deeper skin tones, the lesions might look violet with gray scales, or dark brown and less visible.
Why Nasal Psoriasis is Often Overlooked
Nasal psoriasis is frequently overlooked or misdiagnosed. It is a rare occurrence, making it less immediately recognizable to patients and healthcare providers. The internal location of the symptoms makes self-inspection difficult, which can delay recognition. Additionally, the symptoms of nasal psoriasis can mimic those of more common nasal issues, such as allergies, dryness from environmental factors, or even bacterial infections like nasal vestibulitis. For instance, crusting and dryness are common to several nasal conditions, making differentiation challenging without a thorough examination.
Diagnosis of Nasal Psoriasis
Diagnosing nasal psoriasis involves a healthcare professional’s comprehensive approach. Typically, the process begins with a physical examination of the affected area. A doctor may use a nasal speculum or endoscope for a clearer view. A complete medical history, including any existing psoriasis diagnoses or family history, is also important. In some cases, especially when symptoms are unusual or difficult to distinguish from other conditions, a biopsy of the affected tissue might be necessary to confirm the diagnosis and differentiate psoriasis from other skin disorders.
Treating Nasal Psoriasis
Treatment for nasal psoriasis requires careful consideration due to the sensitive nasal lining. Topical treatments are often the first approach, with low-strength corticosteroids like hydrocortisone 1% commonly prescribed to reduce inflammation. Vitamin D analogues, such as calcipotriol or calcitriol, also help slow skin cell production and reduce inflammation, and can be combined with corticosteroids for enhanced effectiveness. Newer non-steroidal topical creams like tapinarof (Vtama) and roflumilast (Zoryve) offer additional options for localized plaque psoriasis.
For more widespread or severe cases that do not respond to topical treatments, systemic medications may be considered. These oral medications, such as methotrexate, cyclosporine, or acitretin, suppress the immune system’s overactivity. Biologic agents, including medications like adalimumab (Humira) or ustekinumab (Stelara), are another class of systemic treatments targeting specific parts of the immune system involved in psoriasis. Phototherapy, involving controlled exposure to ultraviolet light, can also be an option, as it helps slow skin cell growth and reduce inflammation. Any treatment for nasal psoriasis should always be managed under a doctor’s guidance due to the delicate area and potential side effects.