Spots on the nose may be due to several factors, some affects just the skin while few may be the skin manifestation of systemic disease. In most of the cases dark or black spots on nose are harmless but there are few conditions like melanoma which must be identified as early as possible. So make no mistake and consult dermatologist if you suspect any abnormal spots around the nose. These spots on the nose are usually prominent and can be very annoying which force one to visit the dermatologist. Here, in this article we’ll try to brief some spots on the nose that are commonly encountered in dermatologist office. Please remember that there are several other lesions that can arise on nose and few may be harmful. This article will only focus on flat hyperpigmented lesions.
Melasma which is harmless and common condition seen on cheeks, forehead and the lips can also occur on the nose. This problem is common in women and seen usually during pregnancy which may fade gradually after delivery. These lesions are often light-brown patches with irregular border.
Fixed Drug Eruption
Sometimes fixed drug eruption can also cause grey-brown, oval or round with sharp edges spots on nose. Although several drugs are associated to cause fixed drugs eruption, most common are cotrimoxazole (Bactrim) and naproxen.
Actinic lichen planus
A type of lichen planus which is seen in sun exposed areas like nose. One may notice brown to black patches or flat plaques with irregular border.
Lichen planus pigmentosus
This is another variant of lichen planus which sometimes involves the face and nose and is characterized as brown to greyish black spot.
Acanthosis nigricans which is commonly seen in neck and underarms can also be associated with hyperpigmentation on ala nasi. Severe forms and atypically located lesions can be associated with malignancies.
Freckles are very common pigmented lesions often starting during early childhood and commonly seen in fair skinned individuals. Freckles are harmless, small tan-brown irregular lesion commonly seen on sun exposed areas, especially the nose and cheeks. They tend to be prominent during summer and fade during winter.
Lentigo, especially solar lentigo, is also quite commonly seen in sun exposed areas including nose. They are initially small, brown, yellow-tan to black, sharply circumscribed, pigmented lesion. They slowly increase in size and number. In case of xeroderma pigmentosum, nose is mostly covered with lentigines and freckles.
Lentigo maligna is an early form of lentigo maligna melanoma, a potentially life-threatening form of skin cancer. It can be seen as irregular hyperpigmented spots on the nose. As the lesion advance into invasive stage, the initial flat lesion will slowly progress to raised lesion. Early diagnosis and treatment is very important to avoid further complications.
Some drugs like antimalarial drugs, quinidine and amiadarone can cause drug-induced hyperpigmentation. Such lesions are often bluish grey in color and affects nose along with the cheeks and forehead.
PUVA therapy can also cause hyperpigmentation on sun exposed areas including nose and other areas of the face.
Argyria manifests as slate grey pigmentation on nose and face. Argyria is caused by long term use of products containing silver, resulting in deposition of silver particles in the skin and mucosa. Excessive use of topical cream containing silver
Sulfadiazine may also cause local discoloration
Onchronosis occurs as a result of deposition of homogentisic acid and is usually seen in middle aged individuals. The lesion is mostly seen on the nose and ears and is bluish black or greyish in color with irregular pigmentation.