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- Hemorrhage from the nose involving either the anterior or posterior mucosal surfaces
- Synonym(s): Nosebleed
- In the US: Common
- Estimated lifetime incidence ∼60%
- Bimodal, with peaks in children up to 15 and in adults >50 years
- Rare in children under age 2
- Local irritation from multiple causes (see “Etiology”)
- Medications/Supplements, including aspirin and clopidogrel
- Humidification at night
- Cut fingernails to minimize picking.
- Local vs. systemic disease. Most are due to local causes.
- Anterior: 90–95% of all cases (Kiesselbach plexus)
- Posterior: Usually branches of sphenopalatine arteries: May be asymptomatic or may present with other symptoms
- Local inflammation/irritation:
- Irritant inhalation
- Topical steroid use
- Septal deviation (more air movement on 1 side)
- Low humidity
- Epistaxis digitorum (nose picking)
- Foreign bodies
- Septal perforation
- Sinus fracture
Commonly Associated Conditions
- Vascular malformation/telangiectasia
- Neoplasm (rare, but consider in persistent unilateral cases)
- Coagulopathy: Primary or iatrogenic
- Renal failure
- No proven association with hypertension (HTN), but may make control of bleeding more difficult.