Why is my nasal purpura not healing?

Question

Hi doctor,

Two months ago, I got a cold as I worked in a school, and crusting started to form at the bottom of my nose. I went to the GP the following week, and she suspected it was impetigo, but there were no cases of it anywhere in the school community at this time.

She gave me 250 mg of Amoxicillin to take every day for seven days. Also, after that, spots started to pop up in my mouth, and some clusters of spots, and I was referred to an oral surgeon who said that they did not look cancerous, but sent one spot away to be biopsied under non-urgent conditions, and I got the results of that one week back.

Last month, my lymph nodes started to swell along my jawline. The oral surgeon examined them and said they were fine, and the GP also said the lymph nodes were okay, even though they were swollen. The doctor did a CBC (complete blood count) test. The results showed normal CRP, which was 6.9 m/dL, and high cholesterol at 6.2. mg/dL The GP put me on cholesterol tablets.

Two days back, I went back to the GP to discuss my blood results, as you do, and I told him I had a purpura in my nostril since last month. I just woke up, and it was there. He gave me Bactroban 2% ointment, Mupirocin for the purpura in my nose to use three times a day for ten days, and Amoclav 500 mg taken three times a day for ten days, and a nasal swab was also done.

The purpura is still in my nose, and I am still congested.
The purpura has not changed in size or color and never did bleed or become sore. What could it be, doctor?

My nasal swab showed no beta-hemolytic streptococci isolated and no Staphylococcus aureus isolated.

Please advise

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern and will try to help you with it.

I have carefully reviewed your clinical history and blood test results (attachment removed to protect the identity of the patient).

Overall, your blood work is within normal limits. White blood cells, hemoglobin, and platelets are all within normal range, which indicates no evidence of a significant systemic inflammatory process. The C- reactive protein was only slightly elevated, which most often corresponds to a recent infection or mild inflammation and does not suggest a serious underlying condition.

The oral changes that appeared after antibiotic therapy may be consistent with antibiotic-associated stomatitis (inflammation of tissue lining) or disruption of the normal mucosal microbiota.

Regarding the nasal lesion: in the photo you provided, a blood crust is visible. Since the lesion appears stable, painless, and unchanged in size, it is less likely to represent a dangerous process and is more often related to local irritation of the nasal mucosa or fragility of superficial vessels. It is important to clarify whether this area tends to bleed frequently or only occasionally.

To better understand the situation, I would like to ask a few additional questions:

Do you currently have nasal congestion?
Is your nasal breathing affected?
Do you have any nasal discharge?
What is the typical air temperature in the environment where you spend most of your time?
Also, do you currently have any symptoms in the oral cavity, or have they completely resolved or remained unchanged?

Answer 2

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Sorry for the delay in my response.

Based on your symptoms and clinical course, this presentation most likely corresponds to chronic inflammation of the nasal mucosa. In such cases, the mucosa becomes more sensitive and fragile, so even minimal contact (for example, during hygiene procedures or nasal cleaning) may lead to minor microtrauma and the formation of superficial crusts or poorly granulating areas (tissue that tends to bleed easily). It is quite possible that such minor mechanical irritation contributed to the lesion you are describing.

Based on your history and overall picture (attachment removed to protect the identity of the patient)), this does not appear to be a dangerous process or anything malignant (cancer). It is more consistent with local inflammation and irritation of the nasal mucosa in the context of a post-infectious or allergic process. In this situation, antibiotics are not indicated, as there are no signs of a bacterial complication requiring systemic therapy.

I would recommend local treatment aimed at reducing inflammation and supporting mucosal healing:

Nasonex (Mometasone nasal spray), two sprays in each nostril twice daily for ten days.
Oxolinic ointment 0.25 percent: apply a thin layer to the affected area two to three times daily for five to seven days.
Bepanthen (Dexpanthenol 5 percent), apply a thin layer at night for ten days to promote mucosal healing.

This treatment is aimed at reducing inflammation, protecting the mucosa, and accelerating its recovery.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Yes, such blood spots or crusts in the nasal cavity can persist for weeks and sometimes even longer, especially if the underlying irritation or nasal congestion of the nasal mucosa is ongoing.

This usually happens when the nasal lining becomes chronically inflamed or dry, making the small superficial blood vessels more fragile.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 4

Hi,

Welcome back to icliniq.com.

It was a pleasure speaking with you, and thank you for reaching out. If you have the opportunity, please feel free to send me the results of your investigations once they become available. Wishing you all the best.

Let me know if I can assist you further.

Thank you.