Having a persistently red nose can be concerning for some people. A red nose is often benign and temporary, caused by factors like cold weather or alcohol consumption. However, a chronically red nose may potentially indicate an underlying medical condition. This article will explore the common causes of a red nose, when a red nose may be a cause for concern, and treatment options to help alleviate a persistently red nose.
What causes a red nose?
There are several potential causes for a red nose:
Weather
Cold temperatures can trigger a red nose in many people. When exposed to chilly air, the blood vessels in the nose constrict initially and then dilate, leading to redness. This helps warm the air before it enters the lungs. A red nose in cold weather is very common and not a cause for concern. The redness should resolve once back in a warm environment.
Alcohol consumption
Drinking alcohol causes blood vessels to dilate, particularly those in the face. This leads to a flushed, red appearance in the cheeks and nose. A red nose after drinking is very common and temporary, resolving once the alcohol has been metabolized.
Allergic rhinitis
Seasonal or perennial allergic rhinitis can also lead to a red nose. Allergies cause inflammation of the nasal passages, leading to swelling, sneezing, congestion, and a red nose. Allergy medication can help treat the symptoms.
Rosacea
Rosacea is a chronic skin condition that causes facial redness, including a persistently red nose. Rosacea tends to flare up periodically in response to triggers like sun exposure, spicy foods, alcohol, and stress. Prescription medications can help control rosacea outbreaks.
Lupus
Lupus is an autoimmune disease that can cause a butterfly-shaped facial rash over the nose and cheeks. Other symptoms of lupus include joint pain, fatigue, and fevers. Medications to suppress the overactive immune system are used to treat lupus.
Nasal polyps
Nasal polyps are noncancerous growths that develop in the lining of the nasal passages and sinuses. They can become large and block nasal air flow, leading to a congested, perpetually red nose. Nasal steroid sprays, antibiotics, and surgery can shrink or remove polyps.
Rhinophyma
Rhinophyma is a rare skin condition characterized by a large, red, bumpy nose. It is considered an advanced form of rosacea. Treatment options include laser therapy, dermabrasion, and surgery.
When is a red nose a cause for concern?
While a temporarily red nose after being in the cold or drinking alcohol is normal, there are certain circumstances in which a persistently red nose warrants medical evaluation:
The redness does not resolve
If the nose remains abnormally red for days or weeks without resolution, even after warming up or sobering up, it’s a good idea to get checked out by a doctor. This could indicate an underlying medical condition.
Other symptoms are present
A red nose in the context of additional symptoms like nasal obstruction, nosebleeds, sores, or crusting could signal a more serious nasal condition like an infection, polyps, or autoimmune disease.
It occurs along with a facial rash
A red nose accompanied by a “butterfly rash” on the cheeks and bridge of the nose may be a sign of lupus and requires evaluation. Redness with other skin changes could indicate rosacea.
The skin feels tender
A persistently red nose that feels sore or tender to the touch likely indicates inflammation and swelling. This could be due to rhinitis, rosacea, or other causes needing diagnosis.
There are visible changes
Significant visible changes in the shape or texture of the nose, such as large bumps, swelling, or thickening of the skin, warrant medical assessment. Conditions like rhinophyma and granulomatous diseases can alter nasal appearance.
It occurs with other nasal symptoms
Chronic nasal congestion, runny nose, sneezing, or sinus pressure alongside a red nose are signs of possible nasal inflammation from allergies, sinus infection, or anatomical abnormalities needing evaluation.
Medical conditions that may cause a red nose
Some examples of conditions that can underlie a persistently red nose include:
Rosacea
Rosacea is an inflammatory skin condition that often affects the nose and cheeks, causing redness, bumps, swelling, and dilation of facial blood vessels. It may flare cyclically in response to triggers.
Allergic rhinitis
Seasonal or year-round allergies can cause chronic nasal congestion and swelling, leading to a red nose. This is due to the release of histamines in the nose during allergic reactions.
Autoimmune diseases
Autoimmune conditions like lupus and Sjogren’s syndrome can attack the nasal tissue, potentially causing a red nose and other symptoms. They require lifelong treatment.
Granulomatosis with polyangiitis (GPA)
GPA is a rare autoimmune vasculitis that causes inflammation of the sinuses, lungs, and other organs. Nasal symptoms like redness, crusting, and bleeding can occur.
Nasal vestibulitis
Inflammation of the nasal vestibule (the area just inside the nostrils) due to infection, irritation, or trauma can lead to redness, pain, and crusting of this area.
Rhinophyma
A rare condition causing scar-like thickening and nodularity of the nose, rhinophyma presents as a large, red, bulbous nose. It occurs due to advanced rosacea in some patients.
Carcinoid syndrome
This condition associated with carcinoid tumors can cause facial flushing and redness, including of the nose. It may occur episodically rather than persistently.
Sarcoidosis
Sarcoidosis is an inflammatory disease that can affect the nose, causing redness, sores, stuffiness, and nosebleeds. Nasal sarcoidosis usually occurs alongside other organ involvement.
Diagnosing the cause of a red nose
To determine the underlying reason for a persistently or chronically red nose, a physician will perform:
Medical history
The doctor will ask about your symptoms, any other organ involvement, triggers, occupational exposures, medications, and family history of skin or autoimmune diseases.
Physical exam
Examining your nose for swelling, lesions, ulcers, discoloration, or deformity can help narrow down the diagnosis. They will palpate for tenderness and check your face and inner nose.
Allergy testing
Skin or blood tests can reveal underlying allergies contributing to nasal inflammation, congestion, and redness.
Biopsy
For signs of infection, granulomas, or vasculitis, the doctor may biopsy the nasal tissue to identify causes like GPA or sarcoid.
Blood tests
Blood tests look for elevated white blood cell counts indicating infection or autoantibodies suggestive of lupus. Blood tests can also diagnose carcinoid syndrome.
Imaging
CT scans help identify nasal polyps, tumors, sinus infection, or bony changes from granulomatous diseases.
Rhinoscopy
A small scope inserted in the nose lets doctors visualize the nasal lining for signs of disease, like polyps, lesions, or septal perforations.
Treatments for a persistently red nose
Treatment depends on the specific cause but may involve:
Oral and nasal steroids
Anti-inflammatory corticosteroid medication by mouth or nasal spray helps reduce inflammation from allergies, autoimmune conditions, and rhinophyma.
Antibiotics
Antibiotics treat bacterial infections causing nasal redness and inflammation, especially from sinusitis or nasal vestibulitis.
Isotretinoin
For severe rhinophyma, oral isotretinoin over several months can shrink the enlarged nose and reduce redness.
Surgery
Surgical options like rhinoplasty, excision, dermabrasion, or laser resurfacing can reshape the nose and correct conditions like rhinophyma or vestibulitis.
Immunosuppressants
Medications that lower the immune system help control inflammation from autoimmune diseases like lupus, GPA, or sarcoidosis.
Avoiding triggers
For rosacea, avoiding triggers like sunlight, wind, spicy food, alcohol, and temperature extremes can prevent flares of redness. Proper sunscreen use is vital.
Allergy management
Controlling allergy symptoms with nasal rinses, antihistamines, decongestants, and allergen avoidance helps reduce redness from chronic nasal allergies.
When to see a doctor
Consult a physician promptly if you have:
– A red nose persisting longer than two weeks
– Redness associated with nasal crusting, bleeding, sores, or discharge
– Significantly altered nasal appearance or texture
– Redness following other symptoms like joint pain or rash
– Recurrent episodic nasal flushing
Early diagnosis and treatment can help manage any underlying condition and prevent permanent nasal damage in severe cases. Dermatologists, allergists, rheumatologists, or ENT specialists can help diagnose and treat a red nose refractory to over-the-counter remedies.
Takeaways
– Many cases of a red nose are harmless, often caused by environmental factors.
– Persistent redness for over two weeks, along with other nasal symptoms, warrants medical evaluation.
– Many conditions like rosacea, allergies, autoimmunity, and infections can underlie chronic nasal redness.
– Proper diagnosis via history, exam, testing, and sometimes biopsy can reveal the cause.
– Treatment depends on the diagnosis but may include steroids, antibiotics, immunotherapy, and surgery.
– Prompt diagnosis provides the best opportunity for effective management of a chronically red nose.
Conclusion
While a red nose is common and typically benign in many instances, chronic or persistent redness, especially with other nasal symptoms, can indicate an underlying medical condition needing evaluation. There are numerous potential causes ranging from rosacea to autoimmunity. Consulting a doctor for proper diagnosis and individualized treatment provides the best chance of resolving bothersome nasal redness that does not resolve on its own. With appropriate management, relief from a continuously red nose is possible.