The Rudolph sign of nasal vestibular furunculosis: questions raised by this common but under-recognized nasal mucocutaneous disorder.

Nasal vestibular furunculosis is a mucocutaneous disorder commonly seen in the general population. Despite its prevalence in clinical practice, it has been inconsistently described and labeled in the medical literature. We present a case of nasal vestibular furunculosis presenting as recurrent exquisitely tender unilateral erythema and edema of the nasal tip (i.e., the Rudolph sign--as in Rudolph The Red Nosed Reindeer). This symptom complex responded rapidly to topical intranasal mupirocin ointment treatment after having previously failed other treatments including a topical intranasal triple antibiotic ointment and oral doxycycline. This case is instructive as it describes a heretofore under-recognized, but not uncommon, mucocutaneous clinical entity that has been linked to more serious head and neck infections and likely has relevance to the intranasal carriage of Staphylococcus aureus. We review the limited published literature on this mucocutaneous disorder including its nosology and propose future lines of investigation for better defining its clinical significance and pathogenesis.