Psoriasis is a chronic autoimmune condition that accelerates the life cycle of skin cells, causing them to build up rapidly on the skin’s surface, forming thick, scaly patches called plaques. These plaques are commonly found on the elbows, knees, and scalp. While it is considered an uncommon location, psoriasis can affect the delicate skin in and around the nose, presenting unique challenges for diagnosis and management.
Psoriasis Lesions in the Nasal Cavity
Psoriasis affecting the face is relatively common, occurring in about half of all cases, but the lesions rarely appear solely or primarily on the nose. When the condition does involve this region, it tends to manifest on the skin between the upper lip and the nose, on the sides of the nose, or in the nasal vestibule, which is the area just inside the nostrils. Lesions in this area may not exhibit the classic thick, silvery-white scaling seen on the limbs, due to the constant moisture and friction present in the nasal environment.
Instead, psoriasis in the nose often appears as well-defined, red patches of skin, sometimes with a more subtle, moist scale or crusting. When the condition occurs inside the nostrils, it can lead to dryness, crusting, and occasional bleeding, which may be mistaken for simple nasal dryness or irritation. Because the skin in the nasal vestibule is thin and sensitive, inflammation can be more prominent than scaling. Facial psoriasis, including that on the nose, is often associated with a longer disease duration and a more severe overall presentation of the condition.
Symptoms That Mimic Nasal Psoriasis
Because true psoriasis inside the nose is rare, healthcare providers must first rule out several other common conditions that share similar symptoms. One frequent mimic is Nasal Eczema (atopic dermatitis), which causes an inflamed, itchy rash but typically features thinner patches with less distinct borders than psoriasis. Eczema lesions tend to be dry and may crack or weep, unlike the characteristically raised psoriasis plaques.
Seborrheic Dermatitis commonly affects the folds around the nose where oil glands are abundant, presenting as red areas covered with flaky, often greasy, white or yellow scales. This differs from the drier, silvery scaling of psoriasis. Simple Chronic Rhinitis or environmental dryness can also cause cracking, scabbing, and bleeding inside the nose, often confused with internal nasal psoriasis. These symptoms are generally caused by irritation from low humidity or constant blowing, not a systemic autoimmune response.
Localized bacterial infections, such as Nasal Vestibulitis, can cause pain, swelling, and crusting inside the nostrils that visually resemble a psoriatic flare. Cold sores, caused by the herpes simplex virus, may appear as clusters of blisters that ooze and crust over on or around the nose. A definitive diagnosis often requires a physical examination and sometimes a biopsy to differentiate psoriasis from these other conditions.
Navigating Treatment for Sensitive Areas
Treating psoriasis in the nasal area requires specialized care because the skin is thin and close to mucous membranes, making it highly sensitive to irritation and side effects. Standard high-potency topical steroids used on the elbows or knees are inappropriate for the face and nose, as they can quickly lead to skin thinning (atrophy). Dermatologists often prescribe low-potency topical steroids, such as hydrocortisone 1% ointment, which must still be used sparingly and under close supervision.
Alternatives include non-steroidal topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, which calm the local immune response and inflammation. These agents are favored for sensitive areas because they carry a lower risk of causing skin atrophy than corticosteroids. Moisturizing ointments and barrier creams are also used to soothe dryness and reduce crusting without irritating the delicate tissue.
In cases where the condition is severe or unresponsive to topical methods, a doctor may consider systemic treatments, such as oral medications or biologic therapies. Due to the sensitive location and potential for misdiagnosis, it is important to consult a dermatologist or an ear, nose, and throat specialist (ENT) to ensure the correct diagnosis and establish a safe, effective treatment plan. Patients should avoid using any over-the-counter products inside the nose without first consulting their healthcare provider.