Patient: I have white patches and scabs inside my nose from a two week long cocaine binge. 1 to 2 grams a day each day over a 5 to 10 hour period. Will this go away? Also bad sinus headaches. Was diagnosed with a sinus infection the day after binge but this was before the white patches started turning into scabs. White on surrounding areas that cannot be removed with qtip and scabs on septum area.
Doctor: I understand your concern. The white patches and the scabs are a result of constant irritation to the nasal mucosa which is very sensitive. Yes, this will resolve provided the area is kept clean. Since there are scabs, the chances of developing a staph infection is possible and hence you need to ensure that the area is clean. You can apply vaseline inside the nose to make sure it does not dry up.I will advise you an antihistaminic like levocetirizine 5 mg once daily at bedtime for 3 days. If the patches increase or turn red, it will indicate a bacterial infection warranting an antibiotic course. In such cases, amoxicillin is a good choice as it is first choice antibiotic for local infections concerning upper respiratory tract.The scabs will take 7-10 days to completely disappear. You may require levocetirizine for a longer duration in that case.
Comments / Follow Ups
Patient: Does this need to be prescribed by a doctor? Will the doctor know what has caused this or could there be another cause such as overuse of decongestant sprays? I am having sinus headaches as well and they are extremely painful. What can I use safely to help? I will not be continuing use of cocaine. 2 days free so far.
Doctor: That is great that you have decided not to use cocaine.
You can always mention that you had cold and due to constant nasal picking has caused such scabs. You do not need to mention the cocaine use. Moreover, Levocetirizine is OTC. Only if the scabs do not settle down or seem to get worse, you will need antibiotic, in case of which you need to visit your physician.
For sinus headaches, you can use analgesics like Advil or Naproxen for relief.
Patient: Is flonase safe to use as well for the inflammation? I was prescribed this for the sinus infection but haven’t used it due to possible drug interaction.
Doctor: Yes, you can use Flonase if you have nasal congestion and a runny nose. If not it is not required. It won’t help with irritant inflammation.