Nose and Paranasal Area

Nose and Paranasal Area


The nose has two outstanding features—its prominence and its abundance of sebaceous glands—both of which make it, and its surrounding area, a site prone to develop the most common inflammatory conditions: acne vulgaris, rosacea, seborrheic dermatitis, periorificial dermatitis, as well as sun-related dermatoses. Also, the central location of the nose makes it a cosmetic feature of prime importance.

Many benign neoplasms occur on the nose. They can be easily recognized, particularly in younger patients. Melanocytic nevi, or moles, are extremely common benign facial papules that appear in childhood. Fibrous papules of the nose, also benign, are acquired lesions that first appear in adulthood.

The prominence of the nose also presents it as a prime target for photosensitive disorders (e.g., systemic lupus erythematosus) and the development of ultraviolet-induced premalignant and malignant neoplasms such as actinic keratoses, squamous cell carcinomas, and basal cell carcinomas. Pigmentary lesions such as solar lentigines, and much less commonly, in situ melanoma known as lentigo maligna, may be seen on the nose in the elderly.


Nasal Bridge and Ala Nasi


Distinguishing Features

  • Appears later in life than acne (30 to 50 years of age)

  • Persistent acne-like erythematous papules, pustules, and telangiectasias against a background of erythema (Fig. 6-1)

  • Evidence of rosacea may be seen on the cheeks, eyelids, or sclera (ocular rosacea) (see Eyelids and Periorbital Area and Cheeks)

  • Rosacea lacks the comedones (“blackheads” or “whiteheads”) that are seen in acne


Distinguishing Features

  • Men over 40

  • Consists of knobby nasal papules that tend to become larger and swollen over time (Fig. 6-2)

Cutaneous Sarcoidosis

Distinguishing Features

  • Dermal papules, nodules, or plaques that are brown or violaceous in color

  • Often involves the nasal rim (Fig. 6-3) and periorbital areas (see Fig. 4-14)

  • So-called “apple jelly” nodules are seen upon blanching lesions with a glass slide (diascopy). Such nodules represent the gross appearance of granulomas

Clinical Variant

Lupus pernio, a distinct variant, consists of reddish-purple indurated plaques and nodules around and on the nose. It occurs with a higher frequency in female African Americans and Puerto Ricans and it can be quite disfiguring (Fig. 6-4). It also has a high association in particular with lung involvement by sarcoid.

Fibrous Papule

Distinguishing Features

  • Firm, dome-shaped, flesh-colored, or slightly pink, shiny, smooth papule 2 to 4 mm in size (Fig. 6-5)

  • Hairless

  • Most often occur on the nose; less commonly, elsewhere on the face

  • Similar in appearance to a skin-colored dermal nevus

  • Harmless, but persists unchanged lifelong

Basal Cell Carcinoma

Distinguishing Features

  • Nodular BCC is the most common type

  • Pearly papule or nodule with rolled raised border and telangiectasias (Fig. 6-6)

  • Erosion or ulceration (rodent ulcer)

  • BCCs frequently appear on the ala nasi, nasal creases, nasal tip, and bridge of the nose

Clinical Variant

Pigmented BCC contains melanin; brownish to blue-black coloration that often is seen in more darkly pigmented persons (Fig. 6-7)