Inflammation of the nasal vestibule may result from fol- liculitis of the hairs that line this orifice and is usually the result of nasal manipulation or hair trimming
Systemic antibiotics effective against S aureus (such as dicloxacillin, 250 mg orally four times daily for 7–10 days) are indicated
Topical mupirocin 2% nasal ointment (applied two or three times daily) may be a helpful addition and may prevent future occurrences
If recurrent, the addition of rifampin (10 mg/kg orally twice daily for the last 4 days of dicloxacillin treatment) may eliminate the S aureus carrier state
If a furuncle exists, it should be incised and drained, preferably intranasally
Adequate treatment of these infections is important to prevent retrograde spread of infection through valveless veins into the cavernous sinus and intracranial structures
S aureus is the leading nosocomial pathogen, and nasal carriage is a well-defined risk factor in the development and spread of nosocomial infections
Nasal and extranasal methicillin-resistant S aureus (MRSA) colonization are associated with a 30% risk of developing an invasive MRSA infection during hospital stays
While the vast majority have no vestibulitis symptoms, screening by nasal swabs and PCR-based assays has a demonstrated 30% rate of S aureus colonization in hospital patients and an 11% rate of MRSA colonization in intensive care unit patients
Elimination of the carrier state is challenging, but studies of mupirocin 2% nasal ointment application with chlorhexidine facial washing (40 mg/mL) twice daily for 5 days have demonstrated decolonization in 39% of patients
