A mismanaged case of post herpetic nasal stenosis: a salvage story

Abstract

Acquired nasal stenosis is due to loss of vestibular lining because of scar contracture or direct injury to the lobule-ala-columella complex. We present a patient of Herpes zoster mismanagement with scarring of the right nasal cavity who was treated by placing a stent to achieve nasal patency.  A 47-year-old male, previously diagnosed to have Herpes zoster, presented with complaints of right nasal obstruction, discolouration of skin and burning sensation over the right cheek and nose. He had applied an herbal paste given by quacks which led to scarring and hypopigmentation over the face. He tried peeling the scab off which resulted in a skin contracture and right nasal obstruction. Local examination revealed multiple erythematous hypopigmented plaques over the right maxillary region, scarring over the right lateral aspect of the dorsum, ala and tip and a skin contracture causing stenosis of the right anterior nares. The stenosed area was excised and diagnostic nasal endoscopy showed collapse of the ala and the vestibular region in the right nasal cavity. A red rubber catheter was used as a stent and sutured in place at the ala. Postoperatively, nasal cavity patency was maintained. Herpes zoster is usually self-limiting and treatment with analgesics suffices. Antiviral medication and corticosteroids may alleviate severe pain. However, mismanagement of the lesions by taking local herbal paste and medicines can lead to exacerbation of the lesions and complications like nasal stenosis.