Bumps on the nose. What are these and how do I get rid of them?

Okay, I’m going back to one of the most basic principles of medicine. First, a diagnosis and then treatment. Otherwise, the treatment plans are just empiric, which means based on hunches. And then it’s difficult, maybe impossible, to treat because a correct diagnosis of the nose bumps wasn’t pinned down first. I’m sure you see my point. Nothing is working because the diagnosis of what the nose bumps are may not be correct. And, in your case, the acne treatment is clearly not working.

Strategies to diagnose nose bumps correctly before treatment. 

• Biopsies. These are read by a Pathologist. Bumps on the nose can be caused by at least 10 different things. 3 of them are the most common, as in acne, fibrous papules and sebaceous hyperplasia (enlarged oil gland). There are other things though, and since you’ve had these since age 12, not changing, several other problems need to be considered. You could ask your current dermatologist to do a “shave biopsy.” Or, find another dermatologist and ask their opinion. A shave biopsy takes the lesion off, hopefully without leaving an indented scar. A “punch biopsy” usually need to be sutures and usually leaves a visible scar, but not always. A biopsy provides a definitive diagnosis most of the time. Once a diagnosis is made, treating these becomes easier.
• Cultures and scrapings. These can be sent to the lab for bacteria, fungi, and sometimes rare organisms. Rare ones are usually only an issue if you have been traveling overseas in developing countries. Usually these are not needed for bumps on the nose, but there can be exceptions.
• What to take to an appointment. It will help your doctors to bring any labs done in the past year or so, any prior biopsy reports, all creams, gels, etc that you’ve been using, and any travel history.  Also, if anyone else in the family has these, it may help your doctor also.

Hope this helps,  Dr. I